锁骨上区淋巴结清扫联合局部放疗对sISLM乳腺癌患者远期预后的影响

Influence of Supraclavicular Lymph Node Dissection Combined with Local Radiotherapy on Long-term Prognosis of Breast Cancer Patients with sISLM

目的分析锁骨上区淋巴结清扫联合局部放疗对同时型同侧锁骨上区淋巴结转移(sISLM)乳腺癌患者远期预后的影响。方法回顾性分析2012年1月至2015年12月在开滦总医院治疗的64例sISLM乳腺癌患者的临床资料,其中30例予以单纯局部放疗者为放疗组,34例采用锁骨上区淋巴结清扫联合局部放疗者为联合组。随访至2020年12月,比较两组的无局部区域复发生存期(LRFS)、无局部区域转移生存(DMFS)、无进展生存(PFS)和总生存(OS)。Cox多因素回归分析影响患者预后的相关因素。结果联合组LRFS、DMFS、PFS、OS率分别为78.60%、50.10%、59.70%、68.60%,放疗组分别为81.30%、40.30%、51.00%、68.10%,两组比较差异均无统计学意义(均P>0.05)。死亡组病灶最大直径>5 cm、腋窝淋巴结阳性个数>5个、人类表皮生长因子受体2(HER2)阳性占比高于生存组[89.66%(26/29)比51.43%(18/35),96.55%(28/29)比65.71%(23/35),62.07%(18/29)比20.00%(7/35)](均P<0.01)。Kaplan-Meier法生存分析显示,不同病灶最大直径、腋窝淋巴结阳性个数及HER2阳性与否的生存曲线比较差异有统计学意义(均P<0.01)。Cox多因素回归分析显示,病灶最大直径>5 cm、腋窝淋巴结阳性个数>5个、HER2阳性表达是影响患者死亡的独立危险因素(RR=2.273,95%CI 1.874~2.654;RR=2.250,95%CI 1.856~2.597;RR=2.782,95%CI 2.301~3.124)(均P<0.01)。结论sISLM乳腺癌患者行锁骨上区淋巴结清扫联合局部放疗与单纯局部放疗的远期获益相当,病灶直径、腋窝淋巴结阳性个数、HER2阳性状态是影响患者预后的独立因素。

Objective To analyze the influence of supraclavicular lymph node dissection combined with local radiotherapy on the long-term prognosis breast cancer patients of synchronous ipsilateral supraclavicular lymph node metastasis(sISLM).Methods The clinical data of 60 patients with sISLM breast cancer treated in Kailuan General Hospital from Jan.2012 to Dec.2015 were retrospectively analyzed.Among them,30 patients who received local radiotherapy were assigned into a radiotherapy group,and 34 patients who received supraclavicular lymph node dissection combined with local radiotherapy were assigned into a combined group.Follow-up was done until Dec.2020,and the two groups were compared for loco-regional recurrence-free survival(LRFS),distant metastasis-free survival(DMFS),progression-free survival(PFS)and overall survival(OS).The Cox multivariate regression analysis method was used to analyze the related factors affecting the prognosis of patients.Results The rates of LRFS,DMFS,PFS and OS in the combined group were 78.60%,50.10%,59.70%and 68.60%,respectively,and those in the radiotherapy group were 81.30%,40.30%,51.00%and 68.10%,respectively,with no statistically significant difference between the two groups(all P>0.05).The maximum diameter of lesions>5 cm,positive number of axillary lymph nodes>5,and positive proportion of human epidermal growth factor receptor 2(HER-2)in death group were higher than those in survival group[89.66%(26/29)vs 51.43%(18/35),96.55%(28/29)vs 65.71%(23/35),62.07%(18/29)vs 20.00%(7/35)](all P<0.01).Kaplan-Meier survival analysis showed that the difference of survival curve was statistically significant between different maximum diameter of different lesions,positive number of axillary lymph nodes and positive or not of HER-2(all P<0.01).Cox multivariate regression analysis showed that the maximum diameter of lesion>5 cm,positive number of axillary lymph nodes>5,and positive HER-2 expression were independent risk factors for death(RR=2.273,95%CI 1.874-2.654;RR=2.250,95%CI 1.856-2.597;RR=2.782,95%CI 2.301-3.124)(all P<0.01).Conclusion The long-term benefit of supraclavicular lymph node dissection combined with local radiotherapy for sISLM breast cancer patients is similar to local radiotherapy.The diameter of lesions,the number of axillary lymph nodes and HER-2 positive status are independent factors affecting the prognosis.