78例乳腺癌改良根治术后pT3N0M0期患者放疗价值探讨

Clinical value of radiotherapy in 78 patients with PT3N0M0 breast cancer after modified radical mastectomy

探讨乳腺癌改良根治术后病理分期为T3N0期患者的术后放疗价值。方法 回顾分析1997—2014年收治的乳腺癌改良根治术后患者资料,筛选标准为女性、术后病理提示浸润性癌、肿瘤最大径〉5 cm且腋窝淋巴结未见转移、未接受新辅助化疗及内分泌治疗,且无远处转移及其他第二原发癌。78例符合条件。40例（51%）接受术后放疗,67例（86%）接受辅助化疗。Kaplan-Meier法计算DFS、OS及LRR率,组间差异用Logrank法检验。结果 中位随访时间79个月（6-232个月）,5年OS、DFS和LRR分别为89%、87%和2%。放疗组与未放疗组患者5年DFS分别为84%与91%（P=0.641）,5年OS分别为84%与96%（P=0.126）,5年LRR分别为0%和5%。仅ER/PR状态、分子分型影响患者DFS （P=0.002、0.031）。未放疗组有1例患者出现胸壁复发。结论 乳腺癌改良根治术后T3N0M0期患者LRR率较低,仅ER/PR状态及分子分型影响患者DFS。在有效系统全身治疗基础上术后病理T3N0患者可能不需全部接受胸壁＋锁骨上野放疗,但仍需大样本病例证实。

Objective To investigate the value of post-mastectomy radiotherapy （PMRT） in patients with T3N0 breast cancer （BC） who were treated with modified radical mastectomy （MRM）. Methods A retrospective analysis was performed on the clinical data of BC patients treated with MRM from 1997 to 2014.The inclusion criteria were as follows：（1） female patients;（2） pathological diagnosis of invasive BC;（3） tumor volume greater than 5 cm without axillary lymph node metastasis;（4） the patients who received no neoadjuvant chemotherapy or endocrine therapy and had no distant metastasis or other second primary cancers. A total of 78 patients met the inclusion criteria. Forty patients （51%） received PMRT and sixty-seven patients （86%） received adjuvant chemotherapy. The Kaplan-Meier method was used to calculate overall survival （OS）, disease-free survival （DFS）（DFS）, and local-regional recurrence （LRR） rates, and survival differences between groups were analyzed by the log-rank test. Results The median follow-up time was 79 months （6-232 months）. For all patients, the 5-year OS, DFS, and LRR rates were 89%, 87%, and 2%, respectively. The 5-year DFS, OS and LRR rates for radiotherapy group were 84%, 84% and 0%, respectively, versus 91%（P=0.641）, 96%（P=0.126）, and 5% for non-radiotherapy group. Only estrogen receptor/progesterone receptor （ER/PR） status and molecular type had significant impacts on DFS （P=0.002 and 0.031, respectively）. One patient in non-radiotherapy group had chest wall recurrence. Conclusions MRM is effective in reducing LRR in T3N0M0 BC patients. Only ER/PR status and molecular type significantly influence DFS. Effective systemic therapy may be helpful for some T3N0 patients to avoid chest wall and supraclavicular radiotherapy after MRM, but large-sample studies are needed to further confirm this conclusion.