目的 探讨放疗对不同分子亚型的改良根治术后T1~T2期伴1~3个腋窝淋巴结转移乳腺癌患者的预后影响。方法 将2001-2004年本院行改良根治术的436例乳腺癌患者资料按Luminal A、Luminal B、Her2+、三阴型分子亚型分为4个组,分析各组放疗与未放疗5年局部复发(LR)率、远处转移(DM)率、无瘤生存(DFS)率和总生存(0S)率差别和影响局部复发因素。结果 随访率为86.0%;Luminal A型中放疗的5年LR率低于未放疗的(4.6%:15.8%,x2=5.74,P=0.017),DM、DFS、OS的均相似(17.2%:19.7%,x2=0.17,P=0.682;77.0%:67.1%,x2=1.99,P=0.158;87.4%:85.5%,x2=0.12,P=0.733)。Luminal B型中放疗的5年LR率低于未放疗的(3.7%:12.1%,x2 =4.13,P=0.042),DFS和OS放疗的高于未放疗的[84.0%:57.6%(x2=14.61,P=0.000)和91.4%:70.7% (x2=11.87,P=0.001)],DM的相似(12.3%:22.2%,x2=2.97,P=0.085)。Her2+型中放疗的5年LR率低于未放疗的(5.6%:31.0%,x2 =4.31,P=0.035),DFS放疗的高于未放疗的(61.1%:13.8%,x2=11.44,P=0.001),DM和OS均相似(27.8%:41.4%,x2=0.89,P=0.345和66.7%:48.3%,x2=1.52,P=0.218)。三阴型中LR、DM、DFS、OS的均相似(8.7%:26.1%,x2=2.42,P =0.120;39.1%:47.8%,x2 =0.35,P =0.552;52.2%:26.1%,x2=3.29,P =0.070;65.2%:56.5%,x2=0.37,P=0.546)。多因素分析显示肿瘤大小和放疗为影响局部复发的独立因素(x2 =4.76,P=0.029和x2 =8.06,P=0.005)。结论 改良根治术后T1~T2期伴1~3个腋窝淋巴结转移乳腺癌患者中Luminal A、Luminal B、Her2+型均可从放疗中不同程度获益,而三阴型未显示获益。
目的 探討放療對不同分子亞型的改良根治術後T1~T2期伴1~3箇腋窩淋巴結轉移乳腺癌患者的預後影響。方法 將2001-2004年本院行改良根治術的436例乳腺癌患者資料按Luminal A、Luminal B、Her2+、三陰型分子亞型分為4箇組,分析各組放療與未放療5年跼部複髮(LR)率、遠處轉移(DM)率、無瘤生存(DFS)率和總生存(0S)率差彆和影響跼部複髮因素。結果 隨訪率為86.0%;Luminal A型中放療的5年LR率低于未放療的(4.6%:15.8%,x2=5.74,P=0.017),DM、DFS、OS的均相似(17.2%:19.7%,x2=0.17,P=0.682;77.0%:67.1%,x2=1.99,P=0.158;87.4%:85.5%,x2=0.12,P=0.733)。Luminal B型中放療的5年LR率低于未放療的(3.7%:12.1%,x2 =4.13,P=0.042),DFS和OS放療的高于未放療的[84.0%:57.6%(x2=14.61,P=0.000)和91.4%:70.7% (x2=11.87,P=0.001)],DM的相似(12.3%:22.2%,x2=2.97,P=0.085)。Her2+型中放療的5年LR率低于未放療的(5.6%:31.0%,x2 =4.31,P=0.035),DFS放療的高于未放療的(61.1%:13.8%,x2=11.44,P=0.001),DM和OS均相似(27.8%:41.4%,x2=0.89,P=0.345和66.7%:48.3%,x2=1.52,P=0.218)。三陰型中LR、DM、DFS、OS的均相似(8.7%:26.1%,x2=2.42,P =0.120;39.1%:47.8%,x2 =0.35,P =0.552;52.2%:26.1%,x2=3.29,P =0.070;65.2%:56.5%,x2=0.37,P=0.546)。多因素分析顯示腫瘤大小和放療為影響跼部複髮的獨立因素(x2 =4.76,P=0.029和x2 =8.06,P=0.005)。結論 改良根治術後T1~T2期伴1~3箇腋窩淋巴結轉移乳腺癌患者中Luminal A、Luminal B、Her2+型均可從放療中不同程度穫益,而三陰型未顯示穫益。
목적 탐토방료대불동분자아형적개량근치술후T1~T2기반1~3개액와림파결전이유선암환자적예후영향。방법 장2001-2004년본원행개량근치술적436례유선암환자자료안Luminal A、Luminal B、Her2+、삼음형분자아형분위4개조,분석각조방료여미방료5년국부복발(LR)솔、원처전이(DM)솔、무류생존(DFS)솔화총생존(0S)솔차별화영향국부복발인소。결과 수방솔위86.0%;Luminal A형중방료적5년LR솔저우미방료적(4.6%:15.8%,x2=5.74,P=0.017),DM、DFS、OS적균상사(17.2%:19.7%,x2=0.17,P=0.682;77.0%:67.1%,x2=1.99,P=0.158;87.4%:85.5%,x2=0.12,P=0.733)。Luminal B형중방료적5년LR솔저우미방료적(3.7%:12.1%,x2 =4.13,P=0.042),DFS화OS방료적고우미방료적[84.0%:57.6%(x2=14.61,P=0.000)화91.4%:70.7% (x2=11.87,P=0.001)],DM적상사(12.3%:22.2%,x2=2.97,P=0.085)。Her2+형중방료적5년LR솔저우미방료적(5.6%:31.0%,x2 =4.31,P=0.035),DFS방료적고우미방료적(61.1%:13.8%,x2=11.44,P=0.001),DM화OS균상사(27.8%:41.4%,x2=0.89,P=0.345화66.7%:48.3%,x2=1.52,P=0.218)。삼음형중LR、DM、DFS、OS적균상사(8.7%:26.1%,x2=2.42,P =0.120;39.1%:47.8%,x2 =0.35,P =0.552;52.2%:26.1%,x2=3.29,P =0.070;65.2%:56.5%,x2=0.37,P=0.546)。다인소분석현시종류대소화방료위영향국부복발적독립인소(x2 =4.76,P=0.029화x2 =8.06,P=0.005)。결론 개량근치술후T1~T2기반1~3개액와림파결전이유선암환자중Luminal A、Luminal B、Her2+형균가종방료중불동정도획익,이삼음형미현시획익。
Objective To analyze the role of postmastectomy radiotherapy in different molecular subtypes of breast cancer patients with Stage T1 -T2 and one to three positive axillary nodes. Methods A total of 436 breast cancer patients with T1 -T2 and one to three positive axillary lymph nodes treated with mastectomy and axillary dissection were retrospectively analyzed. Patients were grouped as the following four subtypes:Luminal A, Luminal B, Her2+ and triple-negative. The local recurrence (LR), distant metastasis ( DM ), disease free survival (DFS) and overall survival (OS) rates were compared between paitents with or without radiotherapy in univariate analyses. Multivariate analyses for LR were performed. Results The follow-up rate was 86. 0%. In patients with Luminal A subtype, radiotherapy decreased the 5-year LR rate (4.6% vs 15.8% ,x2 =5.74,P=0.017) but had no influences on DM, DFS or OS rates (17.2% vs 19.7%,x2 =0. 17,P=0.682;77.0% vs 67. 1% ,x2 =1.99,P=0. 158 or87.4%:85. 5% ,x2 =0. 12,P=0. 733 ). In patients with Luminal B subtype, radiotherapy decreased the 5-year LR rate (3.7% vs 12. 1%,x2 =4. 13, P =0. 042), increased DFS and OS ( 84. 0% vs 57.6% ( x2 =14.61, P =0. 000) and 91.4% vs 70. 7% ( x2 =11.87, P =0. 001 ), but had no influence on DM ( 12. 3% vs 22. 2%, x2 =2. 97, P =0. 085).In patients with Her2+ subtype, radiotherapy decreased the 5-year LR rate (5. 6% vs 31.0% ,x2 =4. 31,P=0. 035) , increased DFS (61. 1% vs 13. 8% ,x2 =11.44,P=0.001 ) ,but had no influence on DM and OS (27.8% vs 41.4%, x2 =0. 89, P =0. 345 and 66. 7% vs 48. 3%, x2 =1.52,P =0. 218 ). In patients with triple-negative subtype, radiotherapy had no influence in LR, DM, DFS or OS (8. 7% vs 26. 1% ,x2 =2.42,P=0.120;39.1% vs47.8%,x2=0.35,P=0.552;52.2% vs 26.1% , x2 =3. 29, P =0. 070 or 65.2% vs 56. 5% ,x2 =0. 37 ,P =0. 546). Tumor size and radiotherapy were independent prognostic factors for LR rate in multivariate analyses ( x2 =4. 76, P =0. 029 and x2 =8.06, P =0. 005 ). Conclusions For patients with stage T1 -T2 and one to three positive axillary nodes, patients with all molecular subtypes except triple-negative can benefit from postmasteetomy radiotherapy.