术后放疗对T1～2期伴1～3枚淋巴结转移乳腺癌患者预后的影响  

Effects of post-mastectomy radiation therapy on T1-2 stage and one to three positive lymph node breast cancer patients with different risk factors

作　　者：梁至洁[1] 贾苗苗[1] 陈钦[1] 王静[2] 郑瑛[1] 李玲妹[3] 曹旭晨[4] 

机构地区：[1]天津医科大学肿瘤医院乳腺一科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,乳腺癌防治教育部重点实验室,天津市300060 [2]天津医科大学肿瘤医院放疗科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津市300060 [3]天津医科大学肿瘤医院病理科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津市300060 [4]天津医科大学肿瘤医院乳腺一科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验,室乳腺癌防治教育部重点实验室,天津市300060

出　　处：《中国肿瘤临床》2014年第8期498-502,共5页Chinese Journal of Clinical Oncology

基　　金：天津市自然科学基金项目(编号:11JCZDJC28000)资助~~

摘　　要：目的：研究T1～2期伴1～3枚淋巴结转移乳腺癌患者的预后危险因素，并分析术后放疗对带有不同危险因素患者局部复发及生存的影响。方法：回顾性分析2000年1月至2002年6月457例于天津医科大学肿瘤医院诊治的T1～2期伴1～3枚淋巴结转移乳腺癌患者的生存预后。通过Cox比例风险模型分析明确患者的独立预后因素，并以这些因素进行分层，通过生存分析探究放疗对不同亚组患者预后的影响。结果：放疗对整体患者的生存（HR=0.949，95%CI：0.435～2.074，P=0.896）与复发（HR=0.611，95%CI：0.231～1.614，P=0.320）不是独立有益因素，结外浸润（ECE）和组织学Ⅲ级是预后的独立危险因素。以这两个危险因素分别进行分层分析后发现放疗对具危险因素患者的预后有统计学意义（ECE＋组OS：P=0.020，LRRFS：P=0.014；GradeⅢ组OS：P=0.002，LRRFS：P〈0.001；）对无危险因素组患者的预后无显著性差异（ECE-亚组OS：P=0.353，LRRFS：P=0.796；GradeⅠ~Ⅱ亚组OS：P=0.267，LRRFS：P=0.589）。结论：结外浸润和组织学Ⅲ级是T1～2期伴1～3枚阳性淋巴结乳腺癌患者预后的危险因素，放疗可以明显改善这些带危险因素患者的无局部复发生存和总生存，而对于未发生结外浸润及组织学级Ⅰ~Ⅱ的患者，放疗对预后的影响无显著性差异。Objective：To retrospectively evaluate the prognostic risk factors of T1-2 stage breast cancer patients with one to three positive node（s） and their effects on the benefits of post-mastectomy radiation therapy （PMRT）. Methods：We retrospectively analyzed 457 breast cancer patients with T1-2 stage and one to three positive axillary lymph nodes treated in our hospital between 2000 and 2002. The independent prognostic factors of the patients were calculated by the Cox proportional hazards model. The patients were fur-ther classified into high-risk and low-risk subgroups according to the risk factors to explore the benefit of PMRT on the prognosis of dif-ferent subgroups using survival analysis. Results：PMRT was not an independent beneficial factor of overall survival （OS） （HR=0.949;CI：0.435-2.074;P=0.896） or loco-regional recurrent free survival （LRRFS） （HR=0.611;CI：0.231-1.614;P=0.320） in all patients. Ex-tracapsular extension （ECE） and pathological grades were independent prognostic risk factors, and the benefits of PMRT were signifi-cantly different on the prognosis of high-risk subgroup patients （group ECE＋OS：P=0.020, LRRFS：P=0.014;group GradeⅢOS：P=0.002, LRRFS：P〈0.001）. Meanwhile, PMRT failed to prolong the OS and LRRFS of low-risk subgroup patients （group ECE＋OS：P=0.353, LRRFS：P=0.796;group GradeⅠtoⅡOS：P=0.267, LRRFS：P=0.589）. Conclusion：ECE and gradeⅢwere the independent risk factors of death and loco-regional recurrence in the T1-2 breast cancer patients with one to three positive lymph node（s）. PMRT was an effective adjuvant therapy to improve the prognosis of patients with high-risk factors. However, the benefit of PMRT had no sig-nificance in patients with ECE-or gradeⅠ-Ⅱ.

关 键 词：乳腺癌 放疗 结外浸润 组织学分级 预后 

分 类 号：R737.9[医药卫生—肿瘤]