CAJ | 학술논문

目的分析乳腺癌保乳术后1～3个腋窝淋巴结阳性患者锁骨上淋巴结复发率(SCFR)及高危因素.方法回顾分析2001-2014年本院收治的保乳术+腋窝淋巴结清扫术后乳腺癌患者,病理证实1～3个腋窝淋巴结阳性,无内乳和锁骨上淋巴结转移或远处转移.256例均行全乳腺放疗,剂量46～ 50 Gy(2 Gy/次)或43.5 Gy(2.9 Gy/次),瘤床总剂量50 ～ 70 Gy.245例接受了辅助化疗,45例Her-2受体阳性者18例接受曲妥珠单抗治疗.Kaplan-Meier法计算同侧SCFR、LRR、DM及OS,并Logrank法检验.结果随访时间满5年的样本量为101例.全组5年SCFR、LRR、DM、OS分别为2.1％、2.1％、5.0％、98.0％,2～3个腋窝淋巴结阳性(P=0.010)、脉管瘤栓(P=0.030)、Luminal B型(P=0.006)为锁骨上淋巴结复发的高危因素.腋窝淋巴结阳性数为2～3个和1个者的5年SCFR分别为5.3％和2.8％ (P=0.010);脉管瘤栓阳性和阴性的5年SCFR分别为5.3％和1.8％ (P =0.030);Luminal B型、三阴性、Luminal A型和Her-2阳性型的5年SCFR分别为7.1％、3.2％、1.2％和0％ (P=0.006).有0、1、2～3个高危因素患者的5年SCFR分别为0％、3.0％、10.6％ (P =0.000).结论在接受现代化疗前提下,乳腺癌保乳术后1～3个腋窝淋巴结阳性者SCFR较低,不需要全部行锁骨上区预防照射.有高危因素患者是否行预防性锁骨上区照射需进一步研究.
목적 분석유선암보유술후1～3개액와림파결양성환자쇄골상림파결복발솔(SCFR)급고위인소.방법 회고분석2001-2014년본원수치적보유술+액와림파결청소술후유선암환자,병리증실1～3개액와림파결양성,무내유화쇄골상림파결전이혹원처전이.256례균행전유선방료,제량46～ 50 Gy(2 Gy/차)혹43.5 Gy(2.9 Gy/차),류상총제량50 ～ 70 Gy.245례접수료보조화료,45례Her-2수체양성자18례접수곡타주단항치료.Kaplan-Meier법계산동측SCFR、LRR、DM급OS,병Logrank법검험.결과 수방시간만5년적양본량위101례.전조5년SCFR、LRR、DM、OS분별위2.1％、2.1％、5.0％、98.0％,2～3개액와림파결양성(P=0.010)、맥관류전(P=0.030)、Luminal B형(P=0.006)위쇄골상림파결복발적고위인소.액와림파결양성수위2～3개화1개자적5년SCFR분별위5.3％화2.8％ (P=0.010);맥관류전양성화음성적5년SCFR분별위5.3％화1.8％ (P =0.030);Luminal B형、삼음성、Luminal A형화Her-2양성형적5년SCFR분별위7.1％、3.2％、1.2％화0％ (P=0.006).유0、1、2～3개고위인소환자적5년SCFR분별위0％、3.0％、10.6％ (P =0.000).결론 재접수현대화료전제하,유선암보유술후1～3개액와림파결양성자SCFR교저,불수요전부행쇄골상구예방조사.유고위인소환자시부행예방성쇄골상구조사수진일보연구.
Objective To evaluate the supraclavicular nodal failure (SCF) of the breast cancer patients with one to three positive axillary nodes treated with breast conserving surgery and to identify the risk factors for SCF.Methods From Jan.2001 to Mar.2014,256 breast cancer patients with one to three positive axillary nodes treated with breast conserving surgery and axillary dissection were analyzed.All patients received whole breast radiation to a total dose of 46-50 Gy (median 50 Gy) at 2 Gy/f or 43.5 Gy at 2.9 Gy/f.Tumor bed was boosted to 50-70 Gy (median 60 Gy) at 2 Gy/f or 52.2 Gy at 2.9 Gy/f.No patient received regional nodal radiation.245(95.7％) patients received adjuvant chemotherapy.The SCF,LRR,DM and OS rates were calculated by Kaplan-Meier method and compare by the Logrank test.Results The number of samples were 101 followed up at 5 years.The 5-year SCF,LRR,DM and OS rates were 2.1％,2.1％,5％,98％,respectively.LVI and 2 to 3 positive axillary node and Luminal B were risk factors for SCF (P =0.030,0.010,0.006).The 5-year SCF rate were 5.3％ for patients with 2-3 positive axillary nodes and 2.8％ for those with 1 positive nodes (P =0.010) ; 5.3％ and 1.8％ for those LVI positive and negative (P=0.030) ;7.1％,3.2％,1.2％ and 0％ for Luminal B,Basal,Luminal A and Her-2 positive type (P =0.006).Patients with 0,1 and 2-3 risk factors had 5 year SCF rates of 0％,3.0％ and 10.6％ (P =0.000).Conclusions The supraclavicular nodal recurrence rate is very low for breast cancer patients with one to three positive axillary nodes treated with breast conserving surgery without supraclavicular nodal radiation,indicating that prophylactive supraclavicular nodal is not necessary.Further research is needed to verify whether those patients with risk factors need SCF radiation or not.