放疗对改良根治术后T1～T2期伴1～3个腋窝淋巴结转移乳腺癌不同分子亚型患者预后影响  

The role of postmastectomy radiotherapy in different molecular subtypes of breast cancer patients with T1 - T2 and one to three positive axillary nodes

作　　者：王浩[1] 罗杨坤[1] 王捷[1] 彭瑛[1] 文浩[1] 王卫东[1] 郎锦义[1] 

机构地区：[1]四川省肿瘤医院放疗科,成都610041

出　　处：《中华放射肿瘤学杂志》2011年第5期397-401,共5页Chinese Journal of Radiation Oncology

摘　　要：目的探讨放疗对不同分子亚型的改良根治术后T1～T2期伴1—3个腋窝淋巴结转移乳腺癌患者的预后影响。方法将2001--2004年本院行改良根治术的436例乳腺癌患者资料按Luminal A、Luminal B、Her2＋、三阴型分子亚型分为4个组，分析各组放疗与未放疗5年局部复发（LR）率、远处转移（DM）率、无瘤生存（DFS）率和总生存（0s）率差别和影响局部复发因素。结果随访率为86．0％；Luminal A型中放疗的5年LR率低于未放疗的（4．6％：15．8％，x^2=5．74，P=0．017），DM、DFS、OS的均相似（17．2％：19．7％，X^2=0．17，P=0．682；77．0％：67．1％，x^2=1．99，P=0．158；87．4％：85．5％，x^2=0．12，P=0．733）。Luminal B型中放疗的5年LR率低于未放疗的（3．7％：12．1％，x^2=4．13，P=0．042），DFS和OS放疗的高于未放疗的[84．0％：57．6％（x^2=14．61，P=0．000）和91．4％：70．7％（X^2=11．87，P=0．001）]，DM的相似（12．3％：22．2％，x^2=2．97，P=0．085）。Her2＋型中放疗的5年LR率低于未放疗的（5．6％：31．0％，x^2=4．31，P=0．035），DFS放疗的高于未放疗的（61．1％：13．8％，x^2=11．44，P=0．001），DM和OS均相似（27．8％：41．4％，x^2=0．89，P：0．345和66．7％：48．3％，x^2=1．52，P=0．218）。三阴型中LR、DM、DFS、OS的均相似（8．7％：26．1％，x^2=2．42，P=0．120；39．1％：47．8％，X^2=0．35，P=0．552；52．2％：26．1％，x^2=3．29，P=0．070；65．2％：56．5％，x^2=0．37，P=0．546）。多因素分析显示肿瘤大小和放疗为影响局部复发的独立因素（x^2=4．76，P=0．029和x^2=8．06，P=0．005）。结论改良根治术后T1～T2期伴1～3个腋窝淋巴结转移乳腺癌患者中Luminal A、Luminal B、Her2＋型均可从放疗中不同程度获益，而三阴型未显示获益。Objective To analyze the role of postmastectomy radiotherapy in different molecular subtypes of breast cancer patients with Stage T1 - T2 and one to three positive axillary nodes. Methods A total of 436 breast cancer patients with T1 - T2 and one to three positive axillary lymph nodes treated with mastectomy and axillary dissection were retrospectively analyzed. Patients were grouped as the following four subtypes ： Luminal A, Luminal B, Her2＋ and triple-negative. The local recurrence （LR） , distant metastasis （ DM ）, disease free survival （DFS） and overall survival （OS） rates were compared between paitents with or without radiotherapy in univariate analyses. Multivariate analyses for LR were performed. Results The foflow-up rate was 86. 0%. In patients with Luminal A subtype, radiotherapy decreased the 5-year LR rate （4.6% vs 15.8%,X2 =5.74,P=0.017） but had no influences on DM, DFS or OS rates （17.2% vs 19.7% ,X^2 =0. 17,P=0. 682;77.0% vs 67. 1% ,X^2 = 1.99,P =0. 158 or 87.4%：85.5% ,X^2 =0. 12,P= 0. 733）. In patients with Luminal B subtype, radiotherapy decreased the 5-year LR rate （3.7% vs 12. 1%, X2 = 4. 13,P = 0. 042）, increased DFS and OS （84. 0% vs 57. 6% （ X^2 = 14. 61,P = 0. 000） and 91.4% vs 70. 7% （X^2 = 11.87 ,P =0. 001 ）, but had no influence on DM （ 12. 3% vs 22. 2% ,X2 =2. 97 ,P =0. 085）.In patients with Her2＋ subtype, radiotherapy decreased the 5-year LR rate （5.6% vs 31.0% ,X^2 =4. 31, P =0. 035）, increased DFS （61.1% vs 13.8% ,X^2 = ll. 44,P =0. 001） ,but had no influence on DM and OS （27.8% vs 41.4% ,X^2 = 0.89,P = 0. 345 and 66.7% vs 48.3% , X^2 = 1.52, P = 0. 218）. In patients with triple-negative subtype, radiotherapy had no influe,ce in LR, DM, DFS or OS （8.7% vs 26. 1% ,X2 - 2.42,P=0.120;39.1% vs 47.8%,X^2=0.35,P=0.552;52.2% vs 26. l%,X^2=3.29,P=0.070 or 65.2% vs 56. 5% ,X^2 = 0. 37,P = 0. 546）. Tumor size and radiotherapy were independent prognostic factors for LR rate in multivariate analyses （ X^2 = 4. 76, P = 0. 029 and

关 键 词：乳腺肿瘤/放射疗法 分子亚型 预后 

分 类 号：R737.9[医药卫生—肿瘤]