CAJ | 학술논문

目的探讨早期乳腺癌患者根治术后是否需要接受放疗.方法回顾性分析本院1998年根治术后经病理证实腋窝淋巴结0～3个阳性的乳腺癌患者270例,其中腋窝淋巴结阴性者156例,腋窝淋巴结转移1、2、3个的分别为60、30、24例(114例).定义预后指数≥4分者为高危患者,<4分者为低危患者.生存率计算采用Kaplan-Meier法并Logrank检验.结果腋窝淋巴结阴性与1～3阳性者10年生存率、10年无瘤生存率、平均无瘤生存时间、局部复发率、远处转移率分别为75.0%与63.2%(χ~2=4.40,P=0.036),71.2%与59.6%(χ~2=3.90,P=0.048)、(97.03±2.53)个月与(87.01±3.80)个月(t=2.28,P=0.023)、7.7%与16.7%(χ~2=5.22,P=0.022)、12.8%与21.1%(χ~2=3.27,P=0.070).高危组中未放疗者和放疗者的10年生存率分别为56%和72%(χ~2=4.07,P:0.044),局部复发率分别为24%和5%(χ~2=11.16,P=0.001),远处转移率分别为26%和16%(χ~2=2.18,P=0.140).低危组未放疗和放疗者10年生存率分别为71%和81%(χ~2=1.57,P=0.210),局部复发率分别为11%和11%(χ~2=0.01,P=0.975),远处转移率分别为13%和13%(χ~2=0.00,P=1.000).结论 T_1～T_2期腋窝淋巴结1～3个阳性乳腺癌患者根治术后可考虑放疗,预后指数的应用似乎可选择那些复发概率较大患者,从而尽量减少一部分患者接受不必要放疗.
목적 탐토조기유선암환자근치술후시부수요접수방료.방법 회고성분석본원1998년근치술후경병리증실액와림파결0～3개양성적유선암환자270례,기중액와림파결음성자156례,액와림파결전이1、2、3개적분별위60、30、24례(114례).정의예후지수≥4분자위고위환자,<4분자위저위환자.생존솔계산채용Kaplan-Meier법병Logrank검험.결과 액와림파결음성여1～3양성자10년생존솔、10년무류생존솔、평균무류생존시간、국부복발솔、원처전이솔분별위75.0%여63.2%(χ~2=4.40,P=0.036),71.2%여59.6%(χ~2=3.90,P=0.048)、(97.03±2.53)개월여(87.01±3.80)개월(t=2.28,P=0.023)、7.7%여16.7%(χ~2=5.22,P=0.022)、12.8%여21.1%(χ~2=3.27,P=0.070).고위조중미방료자화방료자적10년생존솔분별위56%화72%(χ~2=4.07,P:0.044),국부복발솔분별위24%화5%(χ~2=11.16,P=0.001),원처전이솔분별위26%화16%(χ~2=2.18,P=0.140).저위조미방료화방료자10년생존솔분별위71%화81%(χ~2=1.57,P=0.210),국부복발솔분별위11%화11%(χ~2=0.01,P=0.975),원처전이솔분별위13%화13%(χ~2=0.00,P=1.000).결론 T_1～T_2기액와림파결1～3개양성유선암환자근치술후가고필방료,예후지수적응용사호가선택나사복발개솔교대환자,종이진량감소일부분환자접수불필요방료.
Objective To study whether post-operative radiotherapy is necessary for patients with early breast cancer after radical mastectomy. Methods In 1998, 270 early breast cancer patients with 0 -3 pathologically confirmed positive axillary lymph nodes after radical mastectomy were retrospectively ana-lyzed. There were 156 patients with negative lymph node and 114 with 1 -3 positive lymph nodes. The prog-nostic index (PI) was defined as the sum of scores of the tumor size, number of positive axillary lymph nodes, receptor status, surgical margin status, lymphatic thrombi status, pathological grading and age. The PI≥ 4 was considered as high-risk, and PI <4 as the low-risk. Numerical variables were compared using t test and categorical variables were compared using chi-square test. Kaplan-Meier method was used to calcu-late the survival rates, and the Log-rank test was used for the comparison of the survival curves between dif-ferent groups. Results Of the patients with lymph node negative and 1 - 3 positive, the survival rates were 75.0% and 63.2% (χ~2 = 4.40 ,P =0.036), respectively. The corresponding disease-free survival rate, lo-cal recurrence rate, distant metastasis rate were 71.2% and 9.6% (χ~2 = 3.90, P = 0.048), 7.7% and 16.7%(χ~2 =5.22,P=0.022),12.8% and 21.1%(χ~2=3.27,P=0.070), respectively. The mean dis-ease-free survival time of the two groups was 97.03 ± 2.53 months and 87.01 ± 3.80 months, respectively. In the high-risk group, the 10-year survival rates of patients with and without radiotherapy were 72% and 56% (χ~2 = 4.07, P = 0.044), the local recurrence rates were 5% and 24% (χ~2= 11.16, P = 0. 001), and the distant metastasis rates were 16% and 26% (χ~2= 2.18 ,P = 0. 140). In the low-risk group, the survival rate of patients with and without radiotherapy were 81% and 71% (χ~2 = 1.57 ,P = 0.210), the local recur-rence rates were both 11% (χ~2=0.01 ,P=0.975), and the distant metastasis rates were both 13% (χ~2 = 0.00,P = 1. 000). Conclusions Early breast cancer patients with 1 -3 positive axiilary lymph nodes should receive post-operative radiotherapy after radical mastectomy. The prognostic index may decrease the chance of unnecessary radiation by distinguishing the patients under low risk of recurrence from those under high risk.