激素受体阴性老年乳腺癌保乳术后豁免放疗的可行性分析

Feasibility of exemption from radiotherapy after breast-conserving surgery for hormone receptor-negative elderly breast cancer

目的 探讨激素受体阴性老年乳腺癌保乳术后豁免放疗的可行性。方法 以2013年12月1日-2018年12月1日南昌大学第二附属医院收治的139例接受保乳手术的雌激素受体(estrogen receptor, ER)及孕激素受体(progesterone receptor, PR)阴性老年乳腺癌患者为研究对象,根据是否接受术后放疗分为病例组(67例未接受术后放疗)与对照组(72例接受术后放疗)。收集并比较两组患者的一般临床病理资料[年龄、肿瘤T分期、肿瘤N分期、肿瘤Nottingham分级、病理类型、人类表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)表达状态、化疗方案],采用Kaplan-Meier法对两组患者的5年无病生存期(DFS)及5年总生存期(OS)进行分析并进行log-rank检验,采用多因素COX比例风险回归模型分析保乳术后豁免放疗对激素受体阴性老年乳腺癌DFS及OS的影响。结果 两组患者的年龄、肿瘤T分期、肿瘤N分期、病理类型、肿瘤Nottingham分级、HER2状态、化疗方案等差异均无统计学意义(P均>0.05)。139例激素受体阴性老年乳腺癌的5年DFS率为74.1%,5年OS率为83.5%。病例组与对照组5年DSF率差异有统计学意义(65.7%vs. 81.9%,P=0.023),5年OS率差异无统计学意义(79.1%vs. 87.5%,P=0.186)。多因素COX比例风险回归模型分析结果显示,保乳术后豁免放疗是激素受体阴性老年乳腺癌患者DFS的独立危险因素(HR=2.298,95%CI:1.113~4.746,P=0.024),但不是OS的独立危险因素(HR=1.831,95%CI:0.740~4.532,P=0.191)。结论 激素受体阴性老年乳腺癌按照保乳术后豁免放疗具有较高的局部复发率,但OS无明显影响,激素受体阴性老年乳腺癌保乳术后是否可豁免放疗仍需进一步的临床试验加以验证。

Objective To explore the feasibility of exemption from radiotherapy after breast-conserving surgery for hormone receptor-negative elderly breast cancer.Methods A total of 139 estrogen receptor(ER)and progesterone receptor(PR)-negative older adults with breast cancer who underwent breast-conserving surgery admitted to the Second Affiliated Hospital of Nanchang University from December 1,2013 to December 1,2018 were recruited as the subjects of the study,and were divided into a case group of 67 patients who did not undergo postoperative radiotherapy and a control group of 72 ones who underwent postoperative radiotherapy,according to whether they received postoperative radiotherapy or not.Clinicopathological data including age,tumor T stage,tumor N stage,tumor Nottingham grade,pathology type,human epidermal growth factor receptor 2(HER2)expression status,and chemotherapy regimen were collected and compared between the two groups.The study analyzed the 5-year disease-free survival(DFS)and 5-year overall survival(OS)of two groups of patients.The log-rank test was used to compare the survival rate,and a multifactorial COX proportional hazards regression model was used to analyze the effect of exempted radiotherapy after breast-conserving surgery on DFS and OS of hormone receptor-negative elderly breast cancer mammary carcinoma.Results The two groups did not significantly differ in age,tumor T-stage,tumor N-stage,pathological type,tumor Nottingham grade,HER2 status,or chemotherapeutic regimen(all P>0.05).The 5-year DFS rate of 139 hormone receptor-negative elderly breast cancer cases was 74.1%and the 5-year OS rate was 83.5%.The difference in the 5-year DSF rate between the case group and the control group was statistically significant(65.7 vs.81.9%,P=0.023),but the difference in the 5-year OS rate was not statistically significant(79.1%vs.87.5%,P=0.186).The results of multifactorial COX proportional risk regression model analysis showed that exemption from radiotherapy after breast-conserving surgery was an independent risk factor for DFS(HR=2.298,95%CI:1.113-4.746,P=0.024),but not for OS(HR=1.831,95%CI:0.740-4.532,P=0.191).Conclusion Hormone receptor-negative elderly breast cancer according to exemption of radiotherapy after breast-conserving surgery has a higher local recurrence rate,but OS has no significant effect.Therefore,whether hormone receptor-negative elderly breast cancer can be exempted from radiotherapy after breast-conserving surgery still needs to be verified by further clinical trials.