新辅助化疗后腋窝阳性淋巴结病理完全缓解对乳腺癌预后的影响

Impact of response of positive axillary nodes to neoadjuvant chemotherapy on breast cancer survival

目的比较腋窝淋巴结病理完全缓解（pCR）与腋窝淋巴结癌残留乳腺癌患者的生存差异。方法回顾性分析376例接受新辅助化疗的腋窝淋巴结阳性乳腺癌患者的临床与病理资料。结果中位随访时间24个月（5～100个月），腋窝淋巴结pCR率30．9％（116／376）。腋窝淋巴结pCR与残留患者的3年无远位转移生存（DDFS）率分别为91．7％与78．8％，生存曲线比较差异有统计学意义（Log-rank检验P=0．016）。多因素分析显示残留患者DDFS风险是pCR患者的2．14倍（P=0．047）；两组无病生存（DFS）曲线比较差异无统计学意义（P〉0．05）。残留组中淋巴结转移数≤3枚与≥4枚患者的DDFS生存曲线比较差异有统计学意义（P=0．001）。结论腋窝淋巴结阳性乳腺癌新辅助化疗后的腋窝淋巴结状态与无远位转移生存相关。

Objective To compare the distant disease-free survival between breast cancer patients with nodal pathological complete response （pCR） and those with nodal residual disease （RD） after neoadjuvant chemotherapy. Methods The clinical and pathological data of 376 needle biopsy proved node positive breast cancer patients undergoing neoadjuvant chemotherapy were retrospectively analyzed. Results The median follow-up time was 24 months （range： 5 - 100）. The pCR rate of axillary lymph node was 30.9%. And the three-year distant disease-free survival （DDFS） rates were 91.7% and 78. 8% in the patients with axillary lymph node pCR and RD respectively. According to the Log-rank test, there were significant differences in survival curves （P =0. 016）. Multivariate analysis showed that the relative risk of DDFS for patients with RD was 2. 14 folds of than that of the pCR group （ P = O. 047 ）. No significant difference existed between the disease-free survival （DFS） curve in two groups. DDFS had significant differences between the patients with the number of lymph node metastasis ~〈 3 and I〉 4 in the RD group （P = 0. 001 ）. Conclusion The distant disease-free survival of node positive breast cancer is associated with the status of axillary lymph node after neoadjuvant chemotherapy.