保乳术后放疗开始时间对早期乳腺癌患者预后的影响

The time effect of radiotherapy after breast-conserving surgery in patients with early breast cancer

目的探讨早期乳腺癌患者行保乳术后放疗开始时间对预后的影响。方法回顾性分析2012年10月至2013年5月期间在我院接受保乳手术治疗的142例早期乳腺癌患者的临床病例资料,其中A组18例患者接受先放疗、后化疗; B组99例患者接受先化疗、后放疗; C组25例患者接受化疗-放疗-化疗夹心治疗,比较3组患者的临床病理特征以及无病生存时间(DFS)情况。采用递归分割(RPA)法对患者进行手术到放疗的分割时间点进行分层,比较DFS的差异。结果 142例患者5年无病生存率为81. 69%。A组5年DFS为83. 3%(15/18),B组为79. 8%(79/99),C组为88. 0%(22/25),3组差异无统计学意义。多因素Cox风险回归模型分析,年龄、脉管癌栓、N分期是影响5年无病生存率的独立因素(P<0. 05)。采用RPA法将患者分为手术至放疗时间间隔≤11周(n=53例)和> 11周(n=89例),两组患者5年无病生存率分别为90. 6%和76. 4%(P=0. 389)。将先化疗组患者分为手术至放疗时间间隔≤23周(n=89例)和>23周(n=35例),5年无病生存率分别为89. 9%和60. 0%(P<0. 05)。将先放疗组患者分为手术至放疗时间间隔≤4. 8周(n=11例)和>4. 8周(n=7例),5年无病生存率分别为90. 9%和71. 4%(P=0. 291)。结论保乳术联合术后放化疗对早期乳腺癌临床疗效良好,但是对于先化疗患者,建议尽早进行放疗,以改善患者预后。

Objective To investigate the effect of radiotherapy initiation time on prognosis of patients with early breast cancer after breast conserving surgery.Methods The clinical data of 142 patients with early breast cancer who underwent breast conserving surgery in our hospital from October 2012 to May 2013 were retrospectively analyzed, including 18 patients in group A received first radiotherapy and then chemotherapy; 99 patients in group B received first chemotherapy and then radiotherapy; 25 patients received chemotherapy-radiotherapy-chemotherapy sandwich therapy. The clinicopathological characteristics and disease-free survival （DFS） of the three groups were compared. Recursive partitioning analysis （RPA） was used to stratify the time points from surgery to radiotherapy, and the differences of DFS were compared.Results In 142 patients, 5-year DFS rate was 81.69%. 5-year DFS rate of group A, group B and group C was 83.3% （15/18）,79.8% （79/99） and 88.0% （22/25）. There was no significant difference among the three groups. Multivariate COX risk regression analysis showed that age, vascular tumor thrombus and N stage were independent factors affecting 5-year DFS （ P 〈0.05）. The patients were divided into two groups by RPA： the interval between operation and radiotherapy was ≤11 weeks （ n =53 cases） and 〉11 weeks （ n =89 cases）. The 5-year DFS rates of the two groups were 90.6% and 76.4% respectively （ P =0.389）. Patients in group B were divided into two groups： the interval between operation and radiotherapy was less than 23 weeks （ n =89 cases） and more than 23 weeks （ n =35 cases）. The 5-year DFS rates of the two groups were 89.9% and 60.0% respectively （ P 〈0.05）. Patients in group C were divided into operation to radiotherapy interval 〈4.8 weeks （ n =11 cases） and 〉4.8 weeks （ n =7 cases）, The 5-year DFS rates of the two groups 90.9% and 71.4% respectively （ P =0.291）.Conclusion Breast conserving surgery combined with postoperative radiotherapy and chemotherapy has a good clinical effect on early breast cancer, but radiotherapy is recommended as early as possible to improve the prognosis of patients with chemotherapy.