摘要
目的 分析研究早期（T1-2N1M0）三阴乳腺癌患者改良根治术后放疗及预后危险因素，为该分期三阴乳腺癌患者临床治疗方案的选择提供依据。方法 回顾性分析2006年1月至2011年10月大连医科大学附属二院收治的术后病理分期为T1-2N1M0三阴乳腺癌患者共87例。根据术后是否放疗将患者分为放疗组（53例），未疗组（34例）。Kaplan-Meier单因素分析术后放疗、年龄、月经、组织学分级、脉管癌栓、T分期、淋巴结阳性数及转移率、手术方式、Ki-67指数等对患者5年局部区域复发率（LRR）、远处转移（DM）率、无复发生存（RFS）率、总生存（OS）率预后的影响。结果 术后放疗组与未疗组5年LRR（9.4%和15.2%）和RFS（81.3%和66.7%）比较，差异有统计学意义（χ2=8.073、12.789，P〈0.05），而DM及OS两组比较差异无统计学意义（P〉0.05）。单因素分析结果显示，放疗、淋巴结转移率、年龄、Ki-67指数是影响5年LRR的危险因素（P〈0.05）；脉管癌栓、淋巴结转移率是影响 5 年 DM 的危险因素（P〈0.05）；放疗、脉管癌栓、淋巴结转移率和Ki-67指数是影响5年 RFS 的危险因素（P〈0.05）。多因素分析结果显示，放疗和淋巴结转移率是影响5年LRR的独立危险因素（HR=0.279、5.277 P〈0.05）；脉管癌栓是影响5年DM的独立危险因素（HR=2.313， P〈0.05）；放疗、脉管癌栓和淋巴结转移率是影响5年RFS 独立危险因素（HR=0.378、2.35、5.084， P〈0.05）。结论 术后放疗可以改善T1-2N1M0期三阴乳腺癌患者的局部控制率，但对5年的DM和OS影响不大。术后放疗、淋巴结转移率、脉管癌栓、Ki-67指数、年龄与早期三阴乳腺癌预后相关。
Objective To analyze the prognostic factors and the value of radiotherapy （RT） for the early stage （T1-2N1M0） triple-negative breast cancer （TNBC） patients after modified radical mastectomy, and provide a basis for the selection of the clinical treatment strategy. Methods The retrospective analysis was performed in 87 TNBC patients at T1-2N1M0 stage. All patients were admitted to the Second Affiliated Hospital of Dalian Medical University from Jan 2006 to Oct 2011. Fifty-three cases received postoperative RT （RT group）, and the other 34 cases without RT （non-RT group）. Factors enrolled in Kaplan-Meier analysis were postoperative RT, age, menstruation, histological grade, vascular tumor thrombus, T staging, the number of positive lymph node and metastasis rate, surgery procedure, Ki-67 index. The endpoints were local regional recurrence rate （LRR）, distant metastasis rate （DM）, recurrence free survival （RFS）, and overall survival （OS） rate for 5 years. Results The significant difference was found in the 5-year LRR （9.4% vs. 15.2%） and RFS （81.3% vs. 66.7%） between RT group and non-RT group （χ2=8.073, 12.789, P〈0.05）. No significant difference in the DM and OS was observed between the two groups （P〉0.05）. The univariate analysis showed that RT, lymph node metastasis, age, and Ki-67 index were the risk factors for 5-year LRR （P〈0.05）, while vascular thrombus and lymph node metastasis rate were risk factors for 5-year DM （P〈0.05）, RT, vascular tumor thrombus, lymph node metastasis rate, and Ki-67 index 5-year RFS （P〈0.05）. The multivariate analysis showed that RT and lymph node metastasis were the independent risk factors for 5-year LRR （HR=0.279, 5.277, P〈0.05）, vascular thrombus was an independent risk factor 5-year DM （HR=2.313, P〈0.05）, while RT, vascular tumor thrombus and lymph node metastasis rate were the independent risk factors for 5 years RFS （HR=0.378, 2.350, 5.084, P〈0.05）. Conclusions Postoperative RT might improve the local control rate of TNBC patients at T1-2N1M0 stage, while the effect on DM and OS in 5 years was little. Postoperative RT, lymph node metastasis rate, vascular tumor thrombus, Ki-67 index and age are related to patient＇s prognosis of early stage TNBC.
作者
张锋
张卓
邹丽娟
宣伟
Zhang Feng;Zhang Zhuo;Zou Lijuan;Xuan Wei(Department of Radiotherapy,Second Affiliated Hospital of Dalian Medical University,Dalian 116027,China;Department of Radiotherapy,Shuyang People＇s Hospital,Shuyan 223600,China)
出处
《中华放射医学与防护杂志》
CAS
CSCD
北大核心
2018年第7期510-516,共7页
Chinese Journal of Radiological Medicine and Protection
关键词
三阴乳腺癌
术后放疗
预后
Triple-negative breast cancer
Postoperative radiotherapy
Prognosis
