结外浸润对于淋巴结阳性乳腺癌患者术后放疗获益的影响

Effects of Extracapsular Extension on Breast Cancer Patients with Positive Lymph Nodes Benefiting from Radiotherapy

目的:研究结外浸润(extracapsular extension,ECE)对腋窝淋巴结阳性乳腺癌患者术后放疗获益的影响。方法:按照患者是否接受放疗和结外浸润状态将1220例淋巴结阳性患者分为"Radio+ECE+"、"Radio-ECE+"、"Radio+ECE-"和"Radio-ECE-"四组,比较四组的局部区域复发率,并通过单因素和多因素分析比较结外浸润对乳腺癌患者无病生存和总生存的影响。结果:结外浸润对于患者的5年和10年的无局部区域复发生存和总生存的影响具有显著的统计学差异,5year LRFFS(82.69%vs.91.83%,P<0.001),10year LRFFS(75.39%vs.90.02%,P<0.001);5year OS(52.12%vs.74.46%,P<0.001),10year OS(35.17%vs.67.63%,P<0.001)。对于1～3枚或≥10枚阳性淋巴结的患者,结外浸润对于术后放疗获益影响不大,但是对于4～9枚阳性淋巴结的患者,结外浸润对于术后放疗获益差异具有统计学意义。结论:无论患者的结外浸润情况如何,术后放疗均不会明显提高1～3枚或≥10枚阳性淋巴结患者的无局部区域复发生存,但是对于4～9枚阳性淋巴结的患者,结外浸润是决定是否接受术后放疗的重要指证。

Obje ctive： This study aimed to evaluate retrospectively the effects of extracapsular extension （ECE） on the benefits of post-mastectomy radiation therapy （PMRT） in patients with different axillary lymph-node positive levels （1-3, 4-9, and ≥10 positive axillary nodes）. Methods： A total of 1220 axillary node-positive patients who had undergone mastectomy, received PMRT or not, and with （ n = 66 ） or without （ n = 24 ） ECE. The patients were divided into four groups based on the ECE status and treatment of PMRT, which were evaluated in terms of the LRR rate. The groups were ＂radio＋ ECE＋,＂ ＂radio-ECE ＋,＂ ＂radio ＋ ECE-,＂ and ＂radio-ECE-.＂ The5- and10 -year Kaplan–Meier disease-free survival （DFS） and overall survival （OS） rates were analyzed. Results： Statistically significant differences were found in the effects of ECE on the 5- and10 -year loco-regional DFS （LRDFS） and OS rates between the ECE and non-ECE groups. The 5-year LRDFS was 82 .69 % vs.91 .83 % （P〈0.001）, the10 -year LRDFS was75 .39 % vs.90 .02 % （P〈0.001）, the5-year OS was 52 .12 % vs.74 .46 % （P〈0.001）, and the 10 -year OS was 35 .17 % vs.67 .63 % （P〈0.001） for the ECE and non-ECE groups, respectively. For patients with 1-3 （P=0.572 0） or ≥10 positive axillary nodes, no apparent effect of ECE was observed on the benefits of PMRT. However, for patients with 4-9 positive axillary nodes, ECE had significant effects on PMRT in terms of the 5- and 10 -year LRDFS rates （ P〈0.05 ）. Conclusion： Regardless of the ECE status, PMRT did not significantly improve the LRDFS rate of patients with 1-3 or ≥10 positive axillary nodes. However, for patients with4-9 positive axillary nodes, ECE can be an important criterion for deciding whether a patient can benefit from PMRT.