T_(2)N_(0)M_(0)三阴性乳腺癌患者复发的危险因素及不同局部治疗方案对预后的影响

Risk Factors of Recurrence and Prognosis in Patients of T_(2)N_(0)M_(0) Triple-Negative Breast Cancer Undergoing Different Therapeutic Modalities

[目的]探讨T_(2)N_(0)M_(0)三阴性乳腺癌(TNBC)患者复发的危险因素及不同局部治疗方案对预后的影响。[方法]采用回顾性病例分析方法,收集了167例T_(2)N_(0)M_(0)TNBC患者的临床病理资料并随访,其中101例患者接受乳房切除术,66例患者接受保乳手术和放疗,采用Kaplan-Meier法计算和绘制生存曲线,采用Cox比例风险回归模型对预后进行分析。[结果]患者中位随访时间为55个月。乳房切除术组和保乳术+放疗组的5年无局部复发生存(LRRFS)率分别为77.22%、93.90%(χ^(2)=4.573,P=0.032),5年无病生存(DFS)率分别为69.30%、84.80%(χ^(2)=3.981,P=0.046),5年总生存(OS)率分别为88.10%、89.40%(χ^(2)=0.035,P=0.852)。Kaplan-Meier生存曲线提示保乳术+放疗组患者疾病进展主要出现在术后前2年,而乳房切除术组患者疾病进展在术后5年持续存在。肿瘤直径>3.5 cm是T_(2)N_(0)M_(0)TNBC患者与DFS (HR=3.602,95%CI:1.490~8.708,P=0.004)相关的独立危险因素。[结论]保乳术+放疗组患者的5年LRRFS率、5年DFS率优于乳房切除术组。相比较于乳房切除术,T_(2)N_(0)M_(0)TNBC患者行保乳术+放疗有获益趋势。因此,对于适合保乳手术的患者,尽量选择行保乳术+放疗;而肿瘤直径>3.5 cm、不适合保乳手术的患者乳房切除术后行放疗可能获益,但还需要前瞻性研究进一步验证。

[Objective]To investigate the risk factors of recurrence in T_(2)N_(0)M_(0) triple-negative breast cancer(TNBC)and the prognosis of patients undergoing different therapeutic modalities.[Methods]The clinicopathological data of 167 patients with T_(2)N_(0)M_(0) TNBC treated in the First Affiliated Hospital of Chongqing Medical University were retrospectively reviewed,including 101 cases treated with mastectomy,and 66 cases treated with breast-conserving surgery and radiotherapy(BCS+RT).The risk factors of recurrence were analyzed with Cox proportional hazards model and the survival of patients was analyzed with Kaplan-Meier method.[Results]The median follow-up time of the patients was 55 months.The 5-year locoregional recurrence free survival(LRRFS)rates in the mastectomy group and BCS+RT group were 77.22%and 93.90%,respectively(χ^(2)=4.573,P=0.032),and the 5-year disease-free survival(DFS)rates were 69.30%and 84.89%,respectively(χ^(2)=3.981,P=0.046),the 5-year overall survival(OS)rates were 88.10%and 89.40%,respectively(χ^(2)=0.035,P=0.852).The Kaplan-Meier survival curve suggested that the disease progression in BCS+RT group was mainly present in the first 2 years after surgery,while those in the mastectomy group persisted in 5 years after surgery.Multivariate Cox regression analysis showed that the tumor size>3.5cm was the only independent risk factor influencing DFS(HR=3.602,95%CI:1.490~8.708,P=0.004)in T_(2)N_(0)M_(0) TNBC patients.[Conclusion]Patients with T_(2)N_(0)M_(0) TNBC receiving BCS+RT treatment have a higher 5-year LRRFS and 5-year DFS compared with mastectomy.Whether patients with tumor size>3.5 cm and not suitable for BCS benefit from postoperative RT should be further verified by prospective studies.