术后放疗对1～3个腋淋巴结阳性的T1～T2期乳腺癌患者预后的影响  

The value of radiotherapy in patients with T1 and T2 breast cancer with one to three positive nodes after modified radical mastectomy

作　　者：乔学英[1] 宋玉芝[1] 耿翠芝[2] 高威[2] 李春晓[2] 周志国[1] 

机构地区：[1]河北医科大学第四医院放疗一科,河北石家庄050011 [2]河北医科大学第四医院外一科,河北石家庄050011

出　　处：《癌症》2010年第4期481-486,共6页Chinese Journal of Cancer

基　　金：河北省普通高校强势特色学科项目(2005-52)~~

摘　　要：背景与目的:对于伴有1～3个腋淋巴结阳性的乳腺癌患者行改良根治术后应用放疗与否一直存在争议。本研究回顾性分析1～3个腋淋巴结转移的T1～T2期乳腺癌患者行改良根治术后放疗或不放疗对其生存的影响。方法:对2001年1月至2006年9月在河北医科大学第四医院行乳腺癌改良根治术的、有1～3个腋淋巴结转移的T1～T2期乳腺癌患者的临床资料进行回顾性分析。434例患者中238例术后未接受放疗(未放疗组);196例接受术后放疗(放疗组),放疗范围为胸壁+同侧锁骨上野照射,总剂量为46～50Gy/23～25次。比较两组患者3年及5年总生存(overall survival,OS)率、局部控制(localcontrol,LC)率和无病生存(disease-free survival,DFS)率。结果:全组病例的3年和5年OS率分别为94.7%和85.7%,3年和5年LC率分别为96.5%和95.6%,3年和5年DFS率分别为89.3%和82.3%。未放疗组和放疗组的3年OS率分别为92.7%和97.1%,5年OS率分别为82.4%和89.2%,差异有统计学意义(P=0.039);3年LC率分别为94.8%和98.4%,5年LC率分别为93.6%和97.7%,差异有统计学意义(P=0.041);3年DFS率分别为87.8%和91.3%,5年DFS率分别为78.5%和86.1%,差异有统计学意义(P=0.047)。结论:术后放疗可提高1～3个腋淋巴结阳性的T1～T2期乳腺癌患者的局控率、总生存率及无病生存率。Background and Objective：The role of adjuvant radiotherapy to the regional nodes in women with T1-T2 breast cancer and one to three positive nodes is controversial. This study compared and analyzed the prognosis of patients with T1-T2 breast cancer with one to three positive nodes after modified radical mastectomy with or without postoperative radiotherapy. Methods：The cases of 434 women patients with T1 to T2 breast cancer with one to three positive lymph nodes after modified radical mastectomy were reviewed,of which 196 patients received postoperative radiotherapy and 238 patients did not. The ipsilateral chest wall and supraclavicular fossa were irradiated with doses of 46-50 Gy in 23-25 fractions. Results：For all patients,the 3-and 5-year rates of overall survival （OS） were 94.7% and 85.7% respectively,local control （LC） 96.5% and 95.6% respectively,and disease-free survival （DFS） 89.3% and 82.3% respectively. The 3-and 5-year OS rates for patients without radiotherapy were 92.7% and 97.1% and for those with radiotherapy were 82.4% and 89.2%,both with significant differences （ P=0.039）. The 3-and 5-year LC rates for patients without radiotherapy were 94.8% and 98.4% and for those with radiotherapy were 93.6% and 97.7%,again with significant differences （ P=0.041）. The 3-and 5-year DFS rates for patients without radiotherapy were 87.8% and 91.3% and for patients with radiotherapy were 78.5% and 86.1% （ P=0.047）. Conclusion：Postoperative radiotherapy confers better rates of OS,LC,and DFS in patients with T1-T2 breast cancer with one to three positive nodes after modified radical mastectomy.

关 键 词：乳腺肿瘤 改良根治术 1-3个阳性淋巴结 术后放疗 预后 

分 类 号：R737.9[医药卫生—肿瘤]