腋窝淋巴结1～3个转移的乳腺癌根治术后辅助放疗指征探讨

Indications for postmastectomy radiotherapy in breast cancer patients with 1 -3 positive axillary nodes

目的 回顾分析412例腋窝淋巴结1～3个转移的乳腺癌根治术后患者的预后因素,探讨术后辅助放疗的指征.方法 用Kaplan-Meier法计算生存率,用Logrank法和Cox模型分别进行单因素和多因素预后分析,分析影响局部复发和远处转移的预后因素.结果 随访率为98.7%.随访满5、10年者分别为215、41例.5、10年总生存率分别为90.0%、81.3%.无、有局部复发的5年总生存率分别为92.9%、69.9%（x2=20.79,P=0.000）.5、10年局部复发±远处转移率分别为10.7%、18.6%.多因素分析显示T2期,≥2个腋窝淋巴结转移,雌、孕激素受体均阴性为影响局部复发的预后因素.含0～1、2～3个预后因素的10年局部复发率分别为3.9%、36.9%（x2=20.64,P=0.000）.多因素分析显示局部复发、阳性淋巴结转移率＞25%为影响远处转移的预后因素,无、有局部复发的5年远处转移率分别为9.7%、36.6%（x2=16.34,P=0.000）.结论 对腋窝淋巴结1～3个转移的乳腺癌根治术后患者且含2～3个影响局部复发的预后因素者建议行术后辅助放疗.

Objective To analyze the prognosis of T1-T2 stage breast cancer with 1 -3 positive axillary nodes after mastectomy, and to explore a subgroup of patients who could benefit from adjuvant radiotherapy. Methods In the retrospective study of 412 eligible patients, survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate analyses were performed using the Log-rank method and Cox regression analysis, respectively. Results The follow-up rate was 98. 7%. 215 and 41patients were followed up for 5 and 10 years,respectively. The 5-and 10-year overall survival （OS） rate was 90. 0% and 81.3%, respectively. The 5-and 10-year locoregional recurrence （LRR） rate was 10. 7% and 18. 6%, respectively. In univariate analysis, T2 statging, more than one positive node, hormone receptornegative （ ER＆PR-negative）, ratio of positive lymph nodes （LNR） ＞ 25%, Her-2 positive, no hormonal therapy were associated with a significantly higher rate of LRR. T2 staging, more than one positive node,hormone receptor-negative were the risk factors for LRR with statistical significance in the multivariate analysis. Basing on these 3 risk factors, the high-risk group （with 2 -3 factors） had a 10-year LRR rate of 36. 9% compared with 3.9% in the low-risk group （ with 0 - 1 factors;x2 =20. 64,P =0. 000）. The 5-year and 10-year distant metastasis （DM） rate was 12.9% and 24. 5%, respectively. LRR, and LNR ＞25%were statistically significant predictors of DM in the multivariate analysis. The 5-year DM rate for patients with LRR was 36. 6% compared with 9. 7% without LRR （x2 = 16. 34,P =0. 000）. The 5-year OS rate for patients with LRR was 69. 9% compared with 92. 9% without LRR （ x2 = 20. 79, P = 0. 000）. LRR was associated with a higher risk of distant metastasis and worse survival. Conclusions LRR after mastectomy has a significant impact on the outcome of patients with T1 -T2 breast cancer and 1 - 3 positive axillary nodes.Patients who have 2 -3 risk factors might benefit from radiotherapy.