改良根治术后pT_(1-2)N_(1)期乳腺癌的局部区域复发部位——12个中心5442例患者的联合分析

Local recurrence pattern of pT_(1-2)N_(1) breast cancer after modified radical mastectomy——a pooled-analysis of 5442 patients from 12 centers

目的分析改良根治术后pT_(1-2)N_(1)期乳腺癌患者的局部区域复发(LRR)部位及放疗对复发的影响。方法收集中国12家医院符合条件的5442例乳腺癌患者资料,分析放疗和未放疗患者的LRR部位及不同部位放疗对复发的影响。采用Kaplan-Meier法计算LRR率并log-rank法检验。结果全组中位随访63.8个月,395例患者出现LRR。无论辅助放疗与否和不同分子分型,胸壁和锁骨上区均为最常见的LRR部位。全组胸壁照射和未照射患者的5年胸壁复发率分别为2.5%和3.8%(P=0.003);锁骨上区照射和未照射患者的5年锁骨上淋巴结复发率分别为1.3%和4.1%(P<0.001);腋窝照射和未照射患者的5年无腋窝复发率分别为0.8%和1.5%(HR=0.31,95%CI为0.04~2.23,P=0.219);内乳照射和未照射患者的5年无内乳复发率分别为0.8%和1.5%(HR=0.45,95%CI为0.11~1.90,P=0.268)。结论改良根治术后pT_(1-2)N_(1)期乳腺癌患者的主要LRR部位是胸壁和锁骨上区,不受辅助放疗与否和分子分型的影响。胸壁和锁骨上区放疗显著降低相应部位的复发风险,而腋窝和内乳放疗未降低相应部位的复发风险。

Objective To analyze locoregional recurrence(LRR)pattern of patients with pT_(1-2)N_(1) breast cancer after modified radical mastectomy,with and without adjuvant radiotherapy(RT).Methods A total of 5442 eligible patients with breast cancer from 12 Chinese centers were included.The LRR sites and the effect of RT at different sites on recurrence in patients with and without RT were analyzed.The Kaplan-Meier method was used to calculate the cumulative LRR rate,and the difference was compared by the log-rank test.Results With a median follow-up time of 63.8 months for the entire cohort,395 patients developed LRR.The chest wall and supraclavicular fossa were the most common LRR sites,regardless of RT or molecular subtypes.The 5-year chest wall recurrence rates for patients with and without chest wall irradiation were 2.5% and 3.8%(P=0.003);the 5-year supraclavicular lymph nodal recurrence rates for patients with and without supraclavicular fossa irradiation were 1.3% and 4.1%(P<0.001);the 5-year axillary recurrence-free rates for patients with and without axillary irradiation were 0.8% and 1.5%(HR=0.31,95%CI:0.04-2.23,P=0.219);and the 5-year internal mammary nodal recurrence-free rates for patients with and without internal mammary nodal irradiation were 0.8% and 1.5%(HR=0.45,95%CI:0.11-1.90,P=0.268).Conclusions The chest wall and supraclavicular fossa are the most common LRR sites of patients with pT_(1-2)N_(1) breast cancer after modified radical mastectomy,which is not affected by adjuvant RT or molecular subtypes.The chest wall and supraclavicular fossa irradiation significantly reduce the risk of recurrence in the corresponding area.However,axillary and internal mammary nodal irradiation has no impact on the risk of recurrence in the corresponding area.