1999-2008年中国乳腺癌根治术后放疗部位变化的临床流行病学研究

Changes in postmastectomy radiotherapy targets among breast cancer patients in China from 1999 to 2008：an epidemiological study

目的了解中国乳腺癌根治术后放疗部位变化。方法随机纳入国内7家医院1999-2008年间乳腺癌根治术后放疗并有详细放疗部位资料的乳腺癌患者资料，分析放疗部位随治疗年代变化情况及不同医院间差别，以及放疗部位与临床病理因素的关系。采用SAS统计软件行Cochran—Armitage趋势检验和x^2检验。结果661例患者中90．2％（596例）、91．5％（606例）、29．6％（196例）和44．9％（297例）患者接受了胸壁、锁骨上下、腋窝和内乳放疗。1999-2008年间胸壁放疗的使用显著增加（P=0．000），腋窝、内乳区的放疗使用显著下降（P=0．027、0．000）。胸壁、腋窝、内乳放疗以及锁骨上下区放疗的使用不同医院间不同（P=0．008、0．000、0．000、0000）。腋窝放疗与腋窝淋巴结状态有关，内乳放疗与原发肿瘤部位有关。结论国内乳腺癌根治术后放疗照射部位在不同年代和不同医院问有很大差别。多数患者接受了胸壁和锁骨上下区放疗，腋窝和内乳的放疗显著下降。

Objective To investigate the changes in postmastectomy radiotherapy （PMRT） targets among breast cancer patients in China. Methods A multi-center retrospective epidemiological study was undertaken. Breast cancer patients who had received PMRT from 1999 to 2008 were randomly selected from seven hospitals in China, and the information on radiation targets, including the chest wall （CW）, supraclavicular and infraelavicular regions （ SCR/ICR ） , axilla, and internal mammary chain （ IMC ） was collected and analyzed. The Cochran-Armitage trend test and chi-square test were performed using SAS software to analyze the variation of PMRT targets over time, the differences in PMRT targets between hospitals, and the relationship between PMRT targets and clinicopathologic characteristics. Results Of 661 included patients, 596（90. 2% ）, 606（91.5% ）, 196（29. 6% ）, and 297（44. 9% ） had received PMRT to the CW, SCR./ICR, axilla, and IMC, respectively. From 1999 to 2008, there were an increase in use of PMRT to the CW （ P = 0. 000 ） and decreases in use of PMRT to the axilla （ P = 0. 027 ） and IMC （ P = 0. 000）. There were significant differences in use of PMRT to the CW （ P = 0. 008 ） , axilla （ P = 0. 000 ） , IMC （P =0. 000） ,and SCR/ICR （P=0. 000） between hospitals, but there were no significant differences in use of PMRT to the SCR/ICR from 1999 to 2008 （ P = 0. 597 ）. Use of PMRT to the axilla was associated with positive axillary nodes （ P = 0. 007 ） and an axillary nodal ratio of 20% or more （ P = 0. 007 ）. Use of PMRT to the IMC was more frequent in patients with tumor located in the inner quadrant （P = 0. 015 ）. Conclusions From 1999 to 2008, PMRT targets among breast cancer patients varied greatly over time and between different hospitals in China; most patients received PMBT to the CW and SCR/ICR, and use of PMRT to the axilla and IMC decreased significantly.