cT1-2N1M0期乳腺癌新辅助化疗和改良根治术后腋窝淋巴结转移0~3枚患者术后放疗的生存分析

Survival analysis of postmastectomy radiotherapy for breast cancer staged in cT1-2N1M0 after neoadjuvant chemotherapy with 0-3 metastatic lymph nodes

目的探讨cT1-2N1M0期乳腺癌新辅助化疗和改良根治术后达到腋窝淋巴结转移0~3枚的患者行术后放疗的价值。方法回顾性分析2000年1月1日至2014年12月31日本院收治的128例临床诊断为T1-2N1M0期乳腺癌患者的临床资料,所有患者均完成新辅助化疗和改良根治手术,术后腋窝淋巴结转移数为0~3枚。根据有无术后放疗将患者分为放疗组(n=87)和未放疗组(n=41),两组术后腋窝淋巴结转移达1~3枚(ypN1)患者分别为43、11例,术后腋窝淋巴结转移0枚(ypN0)患者分别为44、30例。采用Kaplan-Meier法计算患者5年无局部/区域复发生存(LRFS)率、无瘤生存(DFS)率和总生存(OS)率,并进行log-rank检验,单因素分析患者临床特征和治疗对预后的影响。结果128例患者的5年LRFS率、DFS率和OS率分别为91.4%、82.8%和93.0%。放疗组和未放疗组患者的5年LRFS率分别为94.3%和85.4%,差异无统计学意义(χ^2=3.055,P=0.080);5年DFS率分别为89.7%和68.3%,差异有统计学意义(χ^2=9.312,P=0.005);5年OS率分别为94.3%和90.2%,差异无统计学意义(χ^2=0.810,P=0.368)。亚组分析中,放疗组和未放疗组术后达ypN1患者的5年LRFS率分别为93.0%和72.7%,差异有统计学意义(χ^2=4.248,P=0.039);5年DFS率分别为88.4%和63.6%,差异有统计学意义(χ^2=4.525,P=0.033);5年OS率分别为90.7%和81.8%,差异无统计学意义(χ^2=0.713,P=0.399)。放疗组和未放疗组患者术后ypN0患者的5年LRFS率分别为95.5%和90.0%,差异无统计学意义(χ^2=0.872,P=0.350);5年DFS率分别为90.9%和70.0%,差异有统计学意义(χ^2=5.439,P=0.019);5年OS率分别为97.7%和93.3%,差异无统计学意义(χ^2=0.876,P=0.349)。单因素分析结果显示,年龄(χ^2=11.709,P=0.001)和有无脉管瘤栓(χ^2=7.608,P=0.006)是5年LRFS的影响因素,有无术后放疗(χ^2=9.312,P=0.002)是5年DFS的影响因素,年龄(χ^2=6.093,P=0.014)和激素受体状态(χ^2=3.974,P=0.046)是OS的影响因素。结论cT1-2N1M0期乳腺癌经新辅助化疗和改良根治术后ypN1的患者,行术后放疗有局部控制获益,并能改善患者DFS;而cT1-2N1M0期乳腺癌经新辅助化疗和改良根治术后ypN0的患者,术后放疗价值仍需进一步研究。

Objective To investigate the value of postoperative radiotherapy in patients with cT1-2N1M0 breast cancer after neoadjuvant chemotherapy and modified radical mastectomy which postoperative pathology showed that the number of axillary lymph node metastases was 0-3.Methods One hundred and twenty-eight patients diagnosed with cT1-2N1M0 breast cancer admitted to our hospital from January 1,2000 to December 31,2014 were retrospectively reviewed.All patients underwent neoadjuvant chemotherapy and modified radical mastectomy.The number of postoperative axillary lymph node metastases was 0-3.According to whether there was postoperative radiotherapy or not,the whole group of patients was divided into radiotherapy group(n=87)and non-radiotherapy group(n=41).In the two groups after operation,there were 43 and 11 patients with 1-3 axillary lymph node metastases(ypN1),while there were 44 and 30 patients without axillary lymph node metastases(ypN0)respectively.The 5-year locoregional recurrence-free survival(LRFS)rate,disease-free survival(DFS)rate and overall survival(OS)rate were calculated by Kaplan-Meier method,and the differences were compared by log-rank test.Univariate analysis was performed to analyze the effects of clinical features and treatment on prognosis.Results The 5-year LRFS rate,DFS rate and OS rate of 128 patients were 91.4%,82.8%and 93.0%respectively.The 5-year LRFS rates of the patients in the radiotherapy group and the non-radiotherapy group were 94.3%and 85.4%respectively,and the difference was not statistically significant(χ^2=3.055,P=0.080).As well as the 5-year DFS rates were 89.7%and 68.3%respectively,and the difference was statistically significant(χ^2=9.312,P=0.005).The 5-year OS rates were 94.3%and 90.2%respectively,and the difference was not statistically significant(χ^2=0.810,P=0.368).In the subgroup analysis,the 5-year LRFS rates of the patients who had achieved ypN1 in the radiotherapy group and the non-radiotherapy group were 93.0%and 72.7%,and the 5-year DFS rates were 88.4%and 63.6%,with statistically significant differences(χ^2=4.248,P=0.039;χ^2=4.525,P=0.033).The 5-year OS rates were 90.7%and 81.8%respectively,and the difference was not statistically significant(χ^2=0.713,P=0.399).The 5-year LRFS rates of the patients who had achieved ypN0 in the radiotherapy group and the non-radiotherapy group were 95.5%and 90.0%respectively,with no statistically significant difference(χ^2=0.872,P=0.350).The 5-year DFS rates were 90.9%and 70.0%respectively,with statistically significant difference(χ^2=5.439,P=0.019).The 5-year OS rates were 97.7%and 93.3%respectively,with no statistically significant difference(χ^2=0.876,P=0.349).The univariate analysis indicated that age(χ^2=11.709,P=0.001)and blood vessel invasion(χ^2=7.608,P=0.006)were significant influencing factors for 5-year LRFS rate.Postoperative radiotherapy(χ^2=9.312,P=0.002)was a prognostic factor for 5-year DFS rate.Age(χ^2=6.093,P=0.014)and hormone receptor status(χ^2=3.974,P=0.046)were prognostic factors for OS.Conclusion For the cT1-2N1M0 breast cancer patients with 1-3 positive axillary lymph nodes after neoadjuvant chemotherapy,postmastectomy radiotherapy has local control benefit,and it can improve DFS.However,the benefit of postoperative radiotherapy needs to be further investigated in patients with pathological negative axillary lymph nodes after neoadjuvant chemotherapy.