CAJ | 학술논문

目的：探讨术后放射治疗(简称放疗)在新辅助化疗后腋窝淋巴结转移数1~3枚的乳腺癌改良根治术后患者中的作用。方法回顾性分析136例2002年1月至2008年9月于北京大学肿瘤医院接受了新辅助化疗的T1或T2期、腋窝淋巴结转移数1~3枚的改良根治术后乳腺癌患者的临床资料。按患者接受术后放疗与否分为术后放疗组和未放疗组。采用Pearsonχ2检验分析患者临床病理特征在放疗与未放疗组间分布的差异,采用Kaplan-Meier生存分析法比较两组在局部区域复发与生存方面的差异,并采用Cox回归分析进行多因素分析。结果136例患者中,接受术后放疗者占38．2%(52/136),未放疗者占61．8%(84/136)。两组患者在年龄、原发灶临床分期、淋巴结活组织检查、ER状态、HER-2状态以及化疗后原发灶是否达到pCR等方面差异无统计学意义(χ2=0．016、5．790、0．476、0．001、2．612、0．982,P均>0．050)。中位随访时间为88．9(16．5~148．1)个月。放疗组与未放疗组10年无局部区域复发生存率(LRRFS)分别为97．9%和83．5%,差异有统计学意义(u=2．80,P<0．01)；10年无远处转移生存率(DDFS)分别为61．2%和84．0%(u=1．73,P>0．050),10年无瘤生存率(DFS)分别为61．2%和76．8%(u=1．14,P>0．050),10年总生存率(OS)分别为87．7%和83．6%(u=0．45,P>0．050),差异均无统计学意义。多因素分析显示,术后放疗是LRRFS的独立预后因素,未放疗患者局部区域复发风险明显增高(HR=32．8,95%CI：2．6~408．0,P=0．007),但术后放疗不是DDFS、DFS及OS的预后因素。结论术后放疗可以明显减少新辅助化疗后腋窝淋巴结转移数1~3枚的乳腺癌改良根治术后患者的局部区域复发,但对DDFS、DFS及OS无明显影响。
목적：탐토술후방사치료(간칭방료)재신보조화료후액와림파결전이수1~3매적유선암개량근치술후환자중적작용。방법회고성분석136례2002년1월지2008년9월우북경대학종류의원접수료신보조화료적T1혹T2기、액와림파결전이수1~3매적개량근치술후유선암환자적림상자료。안환자접수술후방료여부분위술후방료조화미방료조。채용Pearsonχ2검험분석환자림상병리특정재방료여미방료조간분포적차이,채용Kaplan-Meier생존분석법비교량조재국부구역복발여생존방면적차이,병채용Cox회귀분석진행다인소분석。결과136례환자중,접수술후방료자점38．2%(52/136),미방료자점61．8%(84/136)。량조환자재년령、원발조림상분기、림파결활조직검사、ER상태、HER-2상태이급화료후원발조시부체도pCR등방면차이무통계학의의(χ2=0．016、5．790、0．476、0．001、2．612、0．982,P균>0．050)。중위수방시간위88．9(16．5~148．1)개월。방료조여미방료조10년무국부구역복발생존솔(LRRFS)분별위97．9%화83．5%,차이유통계학의의(u=2．80,P<0．01)；10년무원처전이생존솔(DDFS)분별위61．2%화84．0%(u=1．73,P>0．050),10년무류생존솔(DFS)분별위61．2%화76．8%(u=1．14,P>0．050),10년총생존솔(OS)분별위87．7%화83．6%(u=0．45,P>0．050),차이균무통계학의의。다인소분석현시,술후방료시LRRFS적독립예후인소,미방료환자국부구역복발풍험명현증고(HR=32．8,95%CI：2．6~408．0,P=0．007),단술후방료불시DDFS、DFS급OS적예후인소。결론술후방료가이명현감소신보조화료후액와림파결전이수1~3매적유선암개량근치술후환자적국부구역복발,단대DDFS、DFS급OS무명현영향。
Objective To investigate the effects of radiotherapy after modified radical mastectomy in breast cancer patients with 1-3 positive axillary lymph nodes after neoadjuvant chemotherapy. Methods We retrospectively analyzed the clinical data of 136 stage T1-2 breast cancer patients with 1-3 positive axillary lymph nodes, who underwent neoadjuvant chemotherapy followed by modified radical mastectomy in Beijing Cancer Hospital & Institute from January 2002 to September 2008. They were divided into radiotherapy group and non-radiotherapy group. Pearson χ2 test was used to analyze the difference in clinicopathological characteristics between two groups, Kaplan-Meier method was used to analyze the differences in local-regional recurrence and survival rate, and Cox regression was used for multivariate analysis. Results In 136 patients, 52 patients received postoperative radiotherapy ( 38. 2%, 52/136 ) , and 84 patients received no radiotherapy ( 61. 8%, 84/136). There were no significant differences between two groups in age, clinical stage of primary tumor, lymph node biopsy method, ER status, HER-2 status, and whether to achieve pCR of the primary tumor after chemotherapy(χ2= 0. 016, 5. 790, 0. 476, 0. 001, 2. 612, 0. 982, all P values > 0. 050). All patients were followed up for median 88. 9 months(16. 5-148. 1 months). A significant difference was found in 10-year local-regional recurrent-free survival (LRRFS)between radiotherapy group and non-radiotherapy group (97.9% vs 83. 5%,u=2. 80, P<0. 01), but not in 10-year distant metastasis-free survival (DDFS)(61. 2% vs 84. 0%, u=1. 73, P>0. 050), 10-year disease-free survival (DFS)(61. 2% vs 76. 8%, u=1. 14, P>0. 050), and 10-year overall survival (OS) (87. 7% vs 83. 6%,u=0. 45, P>0. 050). Multivariate analysis showed that postoperative radiotherapy was an independent prognostic factor of LRRFS and the risk of local recurrence significantly increased in the patients undergoing radiotherapy (HR=32. 8,95%CI:2. 6-408. 0, P=0. 007). The postoperative radiotherapy was not a prognostic factor of DDFS, DFS and OS. Conclusion For the breast cancer patients with 1-3 positive axillary lymph nodes after neoadjuvant chemotherapy, radiotherapy after modified radical mastectomy can significantly reduce local-regional recurrence, but without obvious effects on DDFS, DFS and OS.