中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2009年
6期
466-469
,共4页
王淑莲%余子豪%李晔雄%唐源%亓姝楠%曹建忠%王文卿%李涛%金晶%王维虎%宋永文%刘新帆
王淑蓮%餘子豪%李曄雄%唐源%亓姝楠%曹建忠%王文卿%李濤%金晶%王維虎%宋永文%劉新帆
왕숙련%여자호%리엽웅%당원%기주남%조건충%왕문경%리도%금정%왕유호%송영문%류신범
乳腺肿瘤/外科学%乳腺肿瘤/放射疗法%预后
乳腺腫瘤/外科學%乳腺腫瘤/放射療法%預後
유선종류/외과학%유선종류/방사요법%예후
Breast neoplasms/surgery%Breast neoplasms/radiotherapy%Prognosis
目的 总结本院高危乳腺癌患者改良根治术后的治疗结果,探讨放疗的作用和照射野的选择,并对生存预后因素进行分析.方法 回顾性分析381例T_3～T_4期和(或)腋窝淋巴结转移数≥4个的改良根治术后乳腺癌患者临床资料.用Kaplan-Meier法计算生存率,并Logrank法检验.单因素分析临床病理和治疗因素对生存率的影响,多因素分析用Cox回归模型.结果 中位随访时间为48个月.总5年无局部区域复发率为89.7%、总生存率为76.8%.放疗显著提高5年无局部区域复发生存率(93.4%:77.1%,χ~2=19.95,P=0.000)和总生存率(80.9%:62.3%,χ~2=15.47,P=0.001).胸壁和锁骨上区域照射能提高患者的5年无胸壁复发生存率(96.8%:86.2%;χ~2=12.66,P=0.001)和无锁骨上淋巴结复发生存率(97.7%:90.7%,χ~2=9.98,P=0.002),腋窝照射对5年无腋窝复发生存率无影响(98.4%:96.1%,χ~2=0.74,P=0.389).多因素分析显示未放疗(χ~2=14.42,P=0.000)、腋窝淋巴结阳性数≥10个(χ~2=21.60,P=0.000)和T_4期(χ~2=10.79,P=0.001)是总生存率的独立不良预后因素.结论 T_3～T_4期和(或)腋窝淋巴结转移数≥4个乳腺癌患者改良根治术后放疗显著降低局部复发率和提高总生存率,照射部位可选择同侧胸壁和锁骨上淋巴结引流区.
目的 總結本院高危乳腺癌患者改良根治術後的治療結果,探討放療的作用和照射野的選擇,併對生存預後因素進行分析.方法 迴顧性分析381例T_3～T_4期和(或)腋窩淋巴結轉移數≥4箇的改良根治術後乳腺癌患者臨床資料.用Kaplan-Meier法計算生存率,併Logrank法檢驗.單因素分析臨床病理和治療因素對生存率的影響,多因素分析用Cox迴歸模型.結果 中位隨訪時間為48箇月.總5年無跼部區域複髮率為89.7%、總生存率為76.8%.放療顯著提高5年無跼部區域複髮生存率(93.4%:77.1%,χ~2=19.95,P=0.000)和總生存率(80.9%:62.3%,χ~2=15.47,P=0.001).胸壁和鎖骨上區域照射能提高患者的5年無胸壁複髮生存率(96.8%:86.2%;χ~2=12.66,P=0.001)和無鎖骨上淋巴結複髮生存率(97.7%:90.7%,χ~2=9.98,P=0.002),腋窩照射對5年無腋窩複髮生存率無影響(98.4%:96.1%,χ~2=0.74,P=0.389).多因素分析顯示未放療(χ~2=14.42,P=0.000)、腋窩淋巴結暘性數≥10箇(χ~2=21.60,P=0.000)和T_4期(χ~2=10.79,P=0.001)是總生存率的獨立不良預後因素.結論 T_3～T_4期和(或)腋窩淋巴結轉移數≥4箇乳腺癌患者改良根治術後放療顯著降低跼部複髮率和提高總生存率,照射部位可選擇同側胸壁和鎖骨上淋巴結引流區.
목적 총결본원고위유선암환자개량근치술후적치료결과,탐토방료적작용화조사야적선택,병대생존예후인소진행분석.방법 회고성분석381례T_3～T_4기화(혹)액와림파결전이수≥4개적개량근치술후유선암환자림상자료.용Kaplan-Meier법계산생존솔,병Logrank법검험.단인소분석림상병리화치료인소대생존솔적영향,다인소분석용Cox회귀모형.결과 중위수방시간위48개월.총5년무국부구역복발솔위89.7%、총생존솔위76.8%.방료현저제고5년무국부구역복발생존솔(93.4%:77.1%,χ~2=19.95,P=0.000)화총생존솔(80.9%:62.3%,χ~2=15.47,P=0.001).흉벽화쇄골상구역조사능제고환자적5년무흉벽복발생존솔(96.8%:86.2%;χ~2=12.66,P=0.001)화무쇄골상림파결복발생존솔(97.7%:90.7%,χ~2=9.98,P=0.002),액와조사대5년무액와복발생존솔무영향(98.4%:96.1%,χ~2=0.74,P=0.389).다인소분석현시미방료(χ~2=14.42,P=0.000)、액와림파결양성수≥10개(χ~2=21.60,P=0.000)화T_4기(χ~2=10.79,P=0.001)시총생존솔적독립불량예후인소.결론 T_3～T_4기화(혹)액와림파결전이수≥4개유선암환자개량근치술후방료현저강저국부복발솔화제고총생존솔,조사부위가선택동측흉벽화쇄골상림파결인류구.
Objective To analyze the outcome and prognostic factors in breast cancer at high-risk of recurrence and evaluate the role of radiotherapy. Methods 381 breast cancer patients treated with mastec-tomy and axillary dissection were retrospectively analyzed. The including criterias were pathologic diagnosis of invasive breast cancer, T_3-T_4 and/or four or more positive axillary nodes. The survival rates was calculat-ed by Kaplan-Meier method, and compared by Logrank test. Cox regression model was used to select poten-tial prognostic variables. Results The median follow up was 48 months. The 5-year overall survival (OS) and locoregional recurrence-free survival (LRFS) rates were 76.8% and 89.7%, respectively. Radiothera-py significantly improved the OS (80.9% vs. 62.3%, χ~2=15.47, P=0.001) and LRFS (93.4% vs. 77.1% χ~2=19.95,P=0.000). The use of ipsilateral chest wall and supraclavicular nodal radiation was associated with increased 5-year chest wall recurrence free survival (96.8% : 86.2%, χ~2= 12.66, P=0.001) and 5-year supraclavicular node recurrence free survival (97.7% : 90.7 %, χ~2= 9.98, P=0.002).However, axillary irradiation had no impact on 5-year axillary recurrence free survival (98.4% : 96.1% ,χ~2=0.74, P=0.389). In multivariate analysis, absence of radiotherapy (χ~2=14.42, P=0.000), 10 or more positive axillary nodes (χ~2=21.60, P=0.000), and T_4 stage (χ~2=10.79, P=0.001) were inde-pendent unfavorable prognostic factors for overall survival. Conclusions Radiotherapy improves the overall survival of breast cancer patients with T_3, T_4 and/or four or more positive axillary nodes. The chest wall and supraclavicular nodal radiation should be given to this group of patients.
