1～3个腋淋巴结阳性的T_1～T_2期乳腺癌改良根治术后患者预后因素分析

The prognostic factors for patients with T1-2 breast cancer and one to three positive nodes after modified radical mastectomy

目的:分析和研究影响T1～T2期伴1～3个腋淋巴结阳性的乳腺癌改良根治术后患者的预后因素。方法:研究对象为2001年1月—2006年9月接受乳腺癌改良根治术的、有1～3个腋淋巴结阳性的434例T1～T2期乳腺癌患者,其中238例未行术后放疗,196例患者行术后放疗。放疗范围为胸壁+同侧锁骨上野区,总剂量为46～50Gy/23～25次。计算全组患者的3年和5年总生存率、局部控制率和无病生存率,并对影响总生存、局部控制率和无病生存率的因素进行单因素和多因素分析。结果:全组患者的3年和5年总生存率分别为94.7%和85.7%,3年和5年局部控制率分别为96.5%和95.6%,3年和5年无病生存率分别为89.3%和82.3%。单因素分析显示,年龄(P=0.008)和放疗(P=0.039)是影响总生存的预后因素,放疗(P=0.041)是影响局部控制率的预后因素,年龄(P=0.000)、淋巴结阳性数(P=0.037)和放疗(P=0.047)是影响无病生存率的预后因素。多因素分析显示,年龄(P=0.011)是影响总生存的独立预后因素,阳性淋巴结数(P=0.040)和放疗(P=0.020)是影响局部控制率的独立预后因素,年龄(P=0.002)、阳性淋巴结数(P=0.013)和放疗(P=0.039)是影响无病生存率的独立预后因素。结论:术后放疗可提高1～3个腋淋巴结阳性的T1～T2期乳腺癌患者的局部控制率、总生存率和无病生存率。年龄36～50岁患者的预后最好。T1～T2期有1～3个腋淋巴结转移的乳腺癌改良根治术后患者,其阳性淋巴结数越多,预后越差。放疗范围包括胸壁和锁骨上区是可行的。

Objective： To analyze the prognostic factors for patients with T1-2 breast cancer and one to three positive nodes after modified radical mastectomy. Methods： Four hundred and thirty-four female cases of T1-2 breast cancer with one to three positive lymph nodes after modified radical mastectomy between January 2001 and September 2006 were retrospectively reviewed, of whom 196 cases received postoperative radiotherapy and 238 patients didn’t receive it. The ipsilateral chest wall and supraclavicular fossa were irradiated with a total dose of 46-50 Gy in 23-25 fractions. The 3- and 5-year overall survival rates （OSs）, local control rates （LCs） and disease-free survival rates （DFSs） were estimated, and the univariate and multivariate analyses were done for the prognostic factors. Results： For all patients in this study, the 3- and 5-year OS, LC and DFS were 94.7% and 85.7%, 96.5% and 95.6%, and 89.3% and 82.3%, respectively. In the univariate analysis, age （P=0.008） and postoperative radiotherapy （P=0.039） were associated with OS; postoperative radiotherapy was associated with LC （P=0.041）; age （P0.001）, the number of positive lymph nodes （P=0.037） and postoperative radiotherapy （P=0.047） were prognostic factors for DFS. In multivariate analysis, age （P=0.011） was an independent predictor for OS; postoperative radiotherapy （P=0.020） and the number of positive lymph nodes （P=0.040） were independent prognostic factors for LC; the number of positive lymph nodes （P=0.013）age （P=0.002） and postoperative radiotherapy （P=0.039） were the prognostic factors of DFS. Conclusion： Postoperative radiotherapy confers a better OS rate, LC rate and DFS rate in T1-2 breast cancer patients with one to three positive nodes after modified radical mastectomy. The patients between 36 and 50 years have better prognosis. The more positive lymph nodes the patients have, the worse prognosis they will get. The radiation field including ipsilateral chest wall and supraclavicular fossa is feasible.