保乳术后放疗对淋巴结阴性早期三阴性乳腺癌预后的影响

Effect of radiotherapy on survival of patients with lymph node-negative triple-negative breast cancer following breast-conserving surgery

目的比较保乳手术加放疗与乳房切除术不加放疗两种治疗方法对淋巴结阴性的早期三阴性乳腺癌(TNBC)预后的影响。方法选取2003年1月至2018年12月在浙江大学医学院附属邵逸夫医院进行手术治疗的TNBC患者288例。其中144例行保乳手术后辅助放疗,为放疗组;另144例行乳房切除术后未放疗,为未放疗组。比较两组患者的临床病理特征和预后,并分析影响预后的因素。结果与未放疗组相比,放疗组患者更年轻,选择前哨淋巴结活检者更多(均P<0.05)。两组患者T分期、化疗时机、化疗方案、绝经与否、肿瘤位置、组织学类型等比较均无统计学差异(均P>0.05)。放疗组与未放疗组患者5年无病生存率分别为90.97%、84.03%,无局部复发率分别为97.22%、93.75%,无远处转移率分别为93.06%、88.89%,均无统计学差异(均P>0.05)。放疗组患者5年总生存率优于未放疗组(96.53%比88.89%,P<0.05),而两组患者5年乳腺癌特异性生存率比较无统计学差异(96.53%比90.28%,P>0.05)。放疗是影响淋巴结阴性的早期TNBC患者总生存期的独立因素(P<0.05)。结论放疗能改善淋巴结阴性早期TNBC患者的预后,对于T1~2N0M0的TNBC患者,保乳术后放疗相较于乳房切除手术可能是更合适的治疗方法。

Objective To compare the prognosis of patients with lymph node-negative triple-negative breast cancer(TNBC)receiving postoperative radiotherapy following breast-conserving surgery or mastectomy alone.Methods A total of 288 patients with T_(1-2)N_(0)M_(0)TNBC who were operated at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine between January 2003 and December 2018 were enrolled,including 144 patients receiving radiotherapy following breast-conserving surgery(radiotherapy group)and 144 patients receiving mastectomy alone(control group).The clinicopathological characteristics and prognosis in two groups were analyzed.Results Compared with the control group,the patients in the radiotherapy group were younger and had more sentinel lymph node biopsy(both P<0.05).There were no significant differences in T stage,timing of chemotherapy,chemotherapy regimen,menopausal status,tumor location and histological type between the two groups(all P>0.05).There was also no significant differences in 5-year disease free survival(90.97%vs.84.03%),local recurrence free survival(97.22%vs.93.75%),or the distant metastasis free survival(93.06%vs.88.89%)between two groups(all P>0.05).Patients in the radiotherapy group showed significantly better 5-year overall survival(OS)compared to control group(96.53%vs.88.89%,P<0.05).However,when 5-year breast cancer-specific survival(BCSS)was compared between the two groups,no significant difference was found(96.53%vs.90.28%,P>0.05).Radiotherapy was the only factor that had significant effect on OS(P<0.05).Conclusion Radiotherapy can effectively reduce the mortality of node-negative TNBC.Compared to mastectomy alone,radiotherapy after breast conserving surgery may be a more suitable regional treatment for T_(1-2)N_(0)M_(0)TNBC patients.