放疗显著改善HER-2过表达局部晚期乳腺癌改良根治术后LRC率

Radiotherapy following modified radical mastectomy significantly improves locoregional control in patients with Rec-/HER-2＋ locally advanced breast cancer

目的：分析激素受体阴性、HER？2基因过表达局部晚期乳腺癌的局部复发风险和放疗作用。方法回顾分析1999—2011年间294例激素受体阴性、HER？2基因过表达局部晚期乳腺癌患者资料，其中239例接受改良根治术后辅助放疗，55例因各种原因未接受放疗，比较两组生存率和LRR率。 Kaplan？Meier法计算生存率和复发率，Logrank法检验和单因素预后分析，Cox回归模型多因素预后分析。结果5年样本数为162例。全组56例局部复发，5年无LRR率为79．7％，5年OS率为70．0％。放疗显著提高了5年LRRFS率（85．1％和56．0％，P＝0．000），但两组OS率相近（71．3％和64．2％，P＝0．441）。多因素分析显示辅助放疗是无 LRR 影响因素（ RR＝0．303，95％ CI 0．166～0．554，P＝0．000）。结论激素受体阴性、HER？2基因过表达局部晚期乳腺癌术后放疗显著降低了局部复发率。

Objective To evaluate the risk of locoregional recurrence （ LRR ） and role of radiotherapy for patients with estrogen receptor？negative and human epidermal growth factor receptor 2？overexpressed （ Rec？/HER？2＋） locally advanced breast cancer （ LABC ） . Methods A retrospective analysis was performed on the clinical data of 294 patients with Rec？/HER？2＋LABC from 1999 to 2011. All patients were treated with modified radical mastectomy （ MRM ） . Of them, 239 patients received postmastectomy radiotherapy and 55 patients did not. Locoregional recurrence？free survival （ LRRFS） and overall survival （ OS） , as well as LRR, were compared between the two groups. The Kaplan？Meier method was used to estimate survival and recurrence rates, and the log？rank test was used for survival difference analysis and univariate prognostic analysis. Multivariate prognostic analysis was performed using the Cox regression model. Results The 5？year sample size was 162. Fifty？six patients developed LRR. The 5？year LRRFS and OS rates were 79. 7% and 70. 0%, respectively. Postmastectomy radiotherapy significantly increased the 5？year LRRFS rate （ 85. 1% vs. 56. 0%, P=0. 000） , but did not significantly increase the 5？year OS rate （ 71. 3% vs. 64. 2%, P= 0. 441 ） . Multivariate analysis indicated that postmastectomy radiotherapy was the only independent prognostic factor associated with increased LRRFS （ RR=0. 303, 95% CI：0. 166？0. 554, P=0. 000）. Conclusions Patients with Rec？/HER？2＋ LABC treated with MRM alone appear to be at a significantly increased risk of LRR compared with those treated with MRM followed by radiotherapy.