术后放疗对T_1-T_2期乳腺癌患者预后的影响

Influence of postoperative radiotherapy on the prognosis of patients with breast cancer in T_1- T_2

目的：探讨术后放疗对T1-T2期伴有1～3个腋淋巴结转移、腋窝淋巴结清除相对彻底的乳腺癌患者的疗效及其对预后的影响。方法：选择2009年8月1日-2012年1月15日上海交通大学附属第六人民医院收治的185例T1-T2期伴有1～3个腋淋巴结转移的乳腺癌患者为研究对象,分为研究组（n=93）和对照组（n=92）。对照组行乳腺癌改良根治术以及腋窝淋巴结清除术,研究组在此基础上行放疗。观察两组患者1、2、3年总生存率、无病生存率,并分析影响预后的独立危险因素。结果：研究组1、2、3年总生存率分别为97.83%、96.74%、89.13%,与对照组相比,差异无统计学意义（P=0.235 6,P=0.181 2,P=0.128 1）;研究组1、2、3年无病生存率分别为94.57%、92.39%、89.13%,显著高于对照组（P=0.041 8,P=0.039 0,P=0.039 0）;单因素分析表明患者术后无病生存率可能与肿瘤分期、腋窝淋巴结转移数、PR、放疗与否有关,而与患者年龄、ER、月经状态无关,进一步Cox回归分析显示腋窝淋巴结转移数（P=0.046）、放疗与否（P=0.012）是影响无病生存率的独立预后因素。结论：术后放疗可提高T1-T2期伴有1～3个腋淋巴结转移的乳腺癌患者无病生存率,腋窝淋巴结转移以及放疗与否是影响患者预后的独立危险因素。

Objective：To explore the clinical efficacy of postoperative radiotherapy on breast cancer patients in stage Tl - T2 with 1 - 3 axillary lymph node metastasis and relevantly complete axillary lymphadenectomy and its in-fluence on prognosis. Methods： A total of 185 breast cancer patients in stage - T2 with 1 ？3 axillary lymph node metastasis admitted in Shanghai Jiaotong University Affiliated Sixth Peoples Hospital from August 1st,2009 to January 15th ,2012 served as study objects and were divided into research group （ n = 93） and control group （n =92）. Modi-fied radical mastectomy and axillary lymphadenectomy were conducted to control group, on which basis the radiothera-py was added to research group. 1 - ,2 - and 3 - year survival rates and disease - free survival rates of both groups were observed and the independent risk factors influencing the prognosis were analyzed. Results：The 1 - ,2 - and 3 -year survival rates of research group were 97. 83% ,96. 74% and 89. 13% ,respectively,and there was no signifi-cant difference compared with those of control group （P = Q. 235 6 ,P = 0. 1812 ,P = 0.1281 ） . But the disease - free survival rates of research group were 94.57% ,92. 39% and 89. 13% , respectively, evidently higher than those in con-trol group （P=0.041 8,P=0. 039 ,P =0. 039 0 ） . Univariate analysis showed that the disease - free survival rate might be associated with the tumor stages, number of axillary lymph node metastasis, PR and radiotherapy, but had no connection with age,ER and menstrual condition. Further COX regression analysis indicated that the number of axilla-ry lymph node metastasis （P = 0. 046） and radiotherapy （P = 0. 012） were the independent risk factors influencing the patients prognosis. Conclusion ： Postoperative radiotherapy can improve the disease - free survival rate of breast cancer patients in stage T2 - T2 with 1 ～ 3 axillary lymph node metastasis and the number of axillary lymph node me-tastasis and radiotherapy are the independent risk factors influencing the patients prognosis.