乳腺癌新辅助化疗后腋窝淋巴结1～3枚转移的患者改良根治术后放射治疗的疗效分析

Curative effect analysis of radiotherapy after modified radical mastectomy for breast cancer patients with 1-3 positive axillary lymph nodes after neoadjuvant chemotherapy

目的探讨术后放射治疗（简称放疗）在新辅助化疗后腋窝淋巴结转移数1~3枚的乳腺癌改良根治术后患者中的作用。方法回顾性分析136例2002年1月至2008年9月于北京大学肿瘤医院接受了新辅助化疗的T1或T2期、腋窝淋巴结转移数1~3枚的改良根治术后乳腺癌患者的临床资料。按患者接受术后放疗与否分为术后放疗组和未放疗组。采用Pearsonχ2检验分析患者临床病理特征在放疗与未放疗组间分布的差异,采用Kaplan-Meier生存分析法比较两组在局部区域复发与生存方面的差异,并采用Cox回归分析进行多因素分析。结果 136例患者中,接受术后放疗者占38.2%（52/136）,未放疗者占61.8%（84/136）。两组患者在年龄、原发灶临床分期、淋巴结活组织检查、ER状态、HER-2状态以及化疗后原发灶是否达到p CR等方面差异无统计学意义（χ2=0.016、5.790、0.476、0.001、2.612、0.982,P均〉0.050）。中位随访时间为88.9（16.5~148.1）个月。放疗组与未放疗组10年无局部区域复发生存率（LRRFS）分别为97.9%和83.5%,差异有统计学意义（u=2.80,P〈0.01）;10年无远处转移生存率（DDFS）分别为61.2%和84.0%（u=1.73,P〉0.050）,10年无瘤生存率（DFS）分别为61.2%和76.8%（u=1.14,P〉0.050）,10年总生存率（OS）分别为87.7%和83.6%（u=0.45,P〉0.050）,差异均无统计学意义。多因素分析显示,术后放疗是LRRFS的独立预后因素,未放疗患者局部区域复发风险明显增高（HR=32.8,95%CI：2.6~408.0,P=0.007）,但术后放疗不是DDFS、DFS及OS的预后因素。结论术后放疗可以明显减少新辅助化疗后腋窝淋巴结转移数1~3枚的乳腺癌改良根治术后患者的局部区域复发,但对DDFS、DFS及OS无明显影响。

Objective To investigate the effects of radiotherapy after modified radical mastectomy in breast cancer patients with 1- 3 positive axillary lymph nodes after neoadjuvant chemotherapy. Methods We retrospectively analyzed the clinical data of 136 stage T1-2breast cancer patients with 1-3 positive axillary lymph nodes,who underwent neoadjuvant chemotherapy followed by modified radical mastectomy in Beijing Cancer Hospital Institute from January 2002 to September 2008. They were divided into radiotherapy group and nonradiotherapy group. Pearson χ2test was used to analyze the difference in clinicopathological characteristics between two groups,Kaplan-Meier method was used to analyze the differences in local-regional recurrence and survival rate,and Cox regression was used for multivariate analysis. Results In 136 patients,52 patients received postoperative radiotherapy（ 38. 2%,52 / 136）,and 84 patients received no radiotherapy（ 61. 8%,84 / 136）. There were no significant differences between two groups in age,clinical stage of primary tumor,lymph node biopsy method,ER status,HER-2 status,and whether to achieve p CR of the primary tumor after chemotherapy（ χ2= 0. 016,5. 790,0. 476,0. 001,2. 612,0. 982,all P values 0. 050）. All patients were followed up for median 88. 9 months（ 16. 5-148. 1 months）. A significant difference was found in 10-year localregional recurrent-free survival（ LRRFS） between radiotherapy group and non-radiotherapy group（ 97. 9% vs83. 5%,u = 2. 80,P〈0. 01）,but not in 10-year distant metastasis-free survival（ DDFS）（ 61. 2% vs 84. 0%,u = 1. 73,P〉0. 050）,10-year disease-free survival（ DFS）（ 61. 2% vs 76. 8%,u = 1. 14,P〉 0. 050）,and10-year overall survival（ OS）（ 87. 7% vs 83. 6%,u = 0. 45,P〉 0. 050）. Multivariate analysis showed that postoperative radiotherapy was an independent prognostic factor of LRRFS and the risk of local recurrence significantly increased in the patients undergoing radiotherapy（ HR = 32. 8,95% CI： 2. 6- 408. 0,P = 0. 007）.The postoperative radiotherapy was not a prognostic factor of DDFS,DFS and OS. Conclusion For the breast cancer patients with 1- 3 positive axillary lymph nodes after neoadjuvant chemotherapy,radiotherapy after modified radical mastectomy can significantly reduce local-regional recurrence,but without obvious effects on DDFS,DFS and OS.