早期乳腺癌根治术后辅助放疗指征探讨

Indications for postmastectomy radiotherapy in early breast cancer patients

目的 探讨腋窝淋巴结阳性数为1～3个的早期乳腺癌患者根治术后辅助放疗的指征.方法 回顾性分析根治术后并经病理证实腋窝淋巴结阳性数为1～3个的早期乳腺癌患者92例,腋窝淋巴结阳性数为1、2、3个的患者数分别为40、30、22例.其中45例接受同侧胸壁、内乳区及锁骨上淋巴引流区放疗.定义预后指数≥4分者为高危患者,＜4分者为低危患者.采用Kaplan-Meier法计算生存率,并用Logrank法进行检验.结果 放疗患者和未放疗患者的5年生存率分别为93.5％和86.4％（x2=3.43,P＞0.05）,10年生存率分别为73.0％和56.8％（x2=2.82,P＞0.05）,局部复发率为6.7％和19.1％（x2=4.66,P＜0.05）.低危和高危患者中未放疗患者的10年生存率分别为73.0％和56.8％（x2=3.45,P＞0.05）,局部复发率分别为11.0％和24.0％ （x2=4.64,P＜0.05）.低危和高危患者中接受放疗患者的10年生存率分别为82.0％和72.3％（x2=4.07,P＜0.05）,局部复发率分别为11.0％和5.0％（x2=5.64,P＜0.05）.结论 对腋窝淋巴结阳性数为1～3个的早期乳腺癌根治术后且预后指数为高危的患者,建议术后行胸壁和同侧锁骨上淋巴结辅助放疗.

Objective To explore the indications for postmastectomy radiotherapy in early breast cancer patients with 1-3 positive axillary lymph nodes.Methods Ninety-two early breast cancer patients with 1-3 pathologically confirmed positive axillary lymph nodes after radical mastectomy were retrospectively analyzed.Of these patients,45 received irradiation to the lateral chest wall,internal mammary chain and supraclavicular area.The prognostic index ≥ 4 was considered as high-risk,while ＜4 as the low-risk.Survival analysis was performed using the Kaplan-Meier method.The Logrank test was used for the comparison of survival curves between different groups.Results The 5-year survival rates of patients with and without radiotherapy were 93.5％ and 86.4％ （x2=3.43,P＞0.05）,the 10-year survival rates were 73.0％ and 56.8％（x2=2.82,P＞0.05）,the 10-year local recurrence rates wcrc 6.7％ and 19.1％ （x2=4.66,P＜0.05）.The 10-year survival rates of patients with low risk and high risk without radiotherapy were 73.0％ and 56.8％ （x2=3.45,P＞0.05）,while the local recurrence rates were 11.0％ and 24.0％ （x2=4.64,P＜0.05）.The 10-year survival rates of patients with low risk and high risk with radiotherapy were 82.0％ and 72.3％ （x2=4.07,P＜0.05）,while the local recurrence rates were 11.0％ and 5.0％ （x2=5.64,P＜0.05）.Conclusion The early breast cancer patients with 1-3 positive axillary lymph nodes after radical mastectomy and the prognostic index suggests ＂high-risk＂ should receive irradiation to the chest wall and supraclavicular area.