新辅助化疗后N0的早期乳腺癌患者术后放疗的临床价值

The role of postmastectomy radiotherapy for early stage negative axillary node breast cancer patients after neoadjuvant chemotherapy

目的探讨放疗对新辅助化疗后由cT1-2N1M0降期为ypT1-3N0M0的乳腺癌患者预后的影响。方法收集2008-2016年期间54例临床分期为cT1-3N1M0经新辅助化疗后术后分期为ypT0-2N0M0患者,按随机分组的原则分为放疗组和未放疗组,比较两组间3年的生存指标,总生存率、局部复发率与远处转移率,初步评价新辅助化疗后腋窝淋巴结病理缓解的患者辅助放疗的价值,并进一步分析可能影响预后的主要危险因素。结果3年随访率100%,放疗组与未放疗组,3年局部复发率(14.3%vs.15.4%)、远处转移率(10.7%vs.7.7%)、无瘤生存率(82.1%vs.80.8%)、总生存率(100%vs.96.2%),差异均无统计学意义(均P>0.05)。单因素显示脉管癌栓与生存指标相关。结论新辅助化疗后腋窝淋巴结完全缓解的乳腺癌患者需个体化对待放疗,应综合考虑其他的危险因素。

Objective To assess the effect of radiotherapy on the prognosis of breast cancer patients with cT1-3N1M0 down-regulated to ypT0-2N0M0 after neoadjuvant chemotherapy.Methods From 2008 to 2016,47 patients with cT1-3N1M0 were divided randomly into radiotherapy group and non-radiotherapy group after neoadjuvant chemotherapy for ypT0-2N0M0.The 3-year survival indexes were compared between the two groups.Overall survival rate(OS),local recurrence rate(LRR)and distant metastasis rate(DM),were used to evaluate the value of adjuvant radiotherapy in patients with axillary lymph node pathological remission after neoadjuvant chemotherapy,and the main risk factors that may affect the prognosis were further analyzed.Results the 3-year follow-up rate was 100%.There was no significant difference in local recurrence rate,distant metastasis rate,disease-free survival rate and overall survival rate between radiotherapy group and non-radiotherapy group.Univariate analysis showed that vessel tumor thrombus was associated with survival.Conclusion Breast cancer patients with complete axillary lymph node remission after neoadjuvant chemotherapy should be treated individually about radiotherapy and other risk factors should be considered comprehensively.