术后辅助放疗对三阴性乳腺癌患者预后的影响

Effect of postoperative adjuvant radiotherapy on prognosis of triple-negative breast cancer patients

目的系统评价术后放疗对三阴性乳腺癌(Triple-negative breast cancer,TNBC)患者无局部复发生存率(Local recurrence-free survival,LRFS)及总生存率(Overall survival,OS)的影响。方法临床资料来源于哈尔滨医科大学附属肿瘤医院,从2003年1月—2006年12月期间初次发病,并经病理证实为TNBC患者186例,根据术后是否放疗分为放疗组与未放疗组。用Kaplan-Meier法绘制生存曲线,采用Log-rank法比较放疗组与未放疗组10年LRFS和10年OS。应用单因素和多因素分析明确对TNBC患者相关预后因素。结果放疗组和未放疗组的10年LRFS分别为80.2%和76.0%,10年OS分别为86.0%和74.0%,均具有统计学差异(P<0.05)。亚组分析显示对于T_(1-2)N_1(1～3枚淋巴结转移)M_0的患者放疗组10年LRFS及OS都为81.8%,未放疗组的LRFS及OS分别为76.4%和79.4%,两组差异无统计学意义(P>0.05)。多因素分析显示放疗和临床分期是影响TNBC患者预后的独立因素。结论放疗可以提高TNBC患者的LRFS及OS,但对于T_(1-2)N_1(1～3枚淋巴结转移)M_0的TNBC患者,放疗未能显著改善LRFS及OS。放疗和临床分期可能是影响TNBC患者预后的独立因素。

Objective The aim of this study was to evaluate the effect of postoperative radiotherapy on local recurrence-free survival（ LRFS） and overall survival（ OS） in patients with triple-negative breast cancer（ TNBC）. Methods The clinical data of 186 cases for TNBC were collected from the Affiliated Tumor Hospital of Harbin Medical University from January 2003 to December 2006. These cases were confirmed by pathology. The patients were divided into radiotherapy and non-radiotherapy groups. The survival curves were plotted by Kaplan-Meier method. Log-rank test method was used to detect the difference between the radiotherapy and non-radiotherapy groups for 10 years. Univariate and multivariate analyses were used to determine the prognostic factors for TNBC patients. Results The 10-year LRFS of radiotherapy group and non-radiotherapy group were 80. 2% and 76. 0%,respectively. The 10-year OS was 86. 0% and 74. 0% in radiotherapy group and non-radiotherapy group,respectively. Both of them showed a statistically difference（ P 0. 05）. Subgroup analysis showed that LRFS and OS were 81. 8% and 81. 8% in 10 years for radiotherapy in patients with T_（1-2）N_1（ 1-3 lymph node metastases） M_0,respectively,76. 4% and 79. 4% for non-radiotherapy group,respectively. No differences were observed in both of LRFS and OS in radiotherapy and non-radiotherapy groups（ P 0. 05）.Multivariate analysis showed that radiotherapy and clinical staging were independent factors influencing the survival of TNBC patients. Conclusion Radiotherapy can improve the LRFS and OS in TNBC patients,but radiotherapy does not improve LRFS and OS for TNBC patients with T_（1-2）N_1（ 1 ～3 lymph node metastases） M_0. Radiotherapy and clinical staging are independent factors that affect the prognosis of TNBC patients.