乳腺癌保乳治疗的疗效及预后  

Prognosis and risk factors of 1 791 patients with breast cancer treated with breast-conserving surgery based on real-world data

作　　者：陈偲晔 电玉 宋永文 王淑莲 金晶 刘跃平 王维虎 房辉 任骅 孙广毅 王健仰 景灏 张江鹄 刘新帆 余子豪 李晔雄 Chen Siye;Tang Yu;Song Yongwen;Wang Shulian;Jin Jing;Liu Yueping;Wang Weihu;Fang Hui;Ren Hun;Sun Guangyi;Wang Jianyang;Jing Hao;Zhang Jianghu;Liu Xinfan;Yu Zihao;Li Yexiong(Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital,Chinese Academy of Medical Sciences（CAMS）and Peking Union Medical College（PUMC）,Beijing 100021,China)

机构地区：[1]国家癌症中心 国家肿瘤临床医学研究中心 中国医学科学院 北京协和医学院肿瘤医院放疗科,100021

出　　处：《中华肿瘤杂志》2018年第8期619-625,共7页Chinese Journal of Oncology

基　　金：国家重点研发计划（2016YFC0904600）;国家重点基础研究发展计划（973计划）（2013CB91004）

摘　　要：目的总结早期乳腺癌经过保乳治疗的总体疗效，分析并探讨局部区域复发（LRR）、远处转移（DM）和患者生存的影响因素。方法回顾性分析1 791例病理分期为pT1～2N0～3，无锁骨上、内乳淋巴结转移及DM，经保乳治疗而未行新辅助治疗的乳腺浸润性癌患者的临床资料。生存分析的单因素分析采用Kaplan－Meier法和Log rank检验，多因素分析采用Cox回归模型。结果全组患者中位随访4.2年，5年LRR率、DM率、无病生存（DFS）率和总生存（OS）率分别为3.6%、4.6%、93.0%和97.4%。Luminal A型、Luminal B1型、Luminal B2型、HER－2过表达型和三阴型乳腺癌患者的5年LRR率分别为2.0%、6.1%、5.9%、0和10.0%，5年DM率分别为3.2%、6.7%、8.3%、4.8%和7.3%。术后病理N0患者中，689例行腋窝清扫术，652例行前哨淋巴结活检术。5年LRR率分别为3.3%和3.2%，5年OS率分别为98.2%和98.3%，差异均无统计学意义（P值分别为0.859和0.311）。1 576例患者行术后放疗，其5年LRR率较单纯手术患者显著降低（2.5%和12.9%）。常规分割放疗组和大分割放疗组患者的5年LRR率分别为2.7%和3.1%，差异无统计学意义（P＝0.870）。多因素Cox回归分析显示，患者年龄、脉管瘤栓情况、病理T分期、术后放疗、ER或PR状态与内分泌治疗是乳腺癌患者LRR的独立影响因素（均P〈0.05），组织学分级、病理N分期是乳腺癌患者DM的独立影响因素（均P〈0.05），患者年龄、脉管瘤栓情况、病理T分期和N分期、术后放疗、ER或PR状态与内分泌治疗情况是乳腺癌患者DFS的独立影响因素（均P〈0.05），组织学分级、病理N分期、ER或PR状态与内分泌治疗是乳腺癌患者OS的独立影响因素（均P〈0.05）。结论在标准治疗的基础上，保乳治疗后乳腺癌的10年LRR率不到10%。前哨淋巴结活检阴性者不必行腋窝淋巴结清扫。保乳术后放疗使用率较高，大分割放疗与常规�ObjectiveTo investigate the overall efficacy of early breast cancer after breast-conserving treatment. To analyze risk factors affecting local regional recurrence （LRR）, distant metastasis （DM） and survival.Methods1 791 breast cancer patients treated with breast-conserving surgery were retrospectively analyzed. The inclusion criteria were pathologic diagnosis of invasive breast cancer without supraclavicular and internal mammary node metastasis, T1-2N0-3M0, and no neoadjuvant therapy. Univariate analysis of survival was performed by Kaplan-Meier method and log rank test. Cox regression model was used for multivariate analysis.ResultsThe median follow-up time was 4.2 years. For all patients, the 5-year LRR, DM, disease-free survival（DFS） and overall survival（OS） rates were 3.6%, 4.6%, 93.0% and 97.4%, respectively. The LRR rates of patients with Luminal A, Luminal B1, Luminal B2, HER-2 over-expressed and triple-negative breast cancer were 2.0%, 6.1%, 5.9%, 0 and 10.0%, while the DM rates were 3.2%, 6.7%, 8.3%, 4.8% and 7.3%, respectively. Among the N0 patients, axillary dissection was performed in 689 cases and sentinel lymph node biopsy in 652 cases. The 5-year LRR rates were 3.3% and 3.2% （P=0.859）, and the OS rates were 98.2% and 98.3% （P=0.311） respectively, which showed no statistically significant. There were 1 576 patients that underwent postoperative radiotherapy. Postoperative radiotherapy significantly reduced the 5-year LRR compared with surgery alone （2.5% vs 12.9%）. The 5-year LRR rates of patients who received conventional fractionated radiotherapy and hypo-fractionated radiotherapy were 2.7% and 3.1%, respectively. But the difference was not statistically significant （P=0.870）. Multivariate analysis showed that age, lymphovascular invasion, pathological T staging, postoperative radiotherapy, ER/PR status and endocrine therapy were independent factors of LRR in breast cancer patients （all P〈0.05）. Histological grade and pathological N staging were independent fac

关 键 词：乳腺肿瘤 术后放射疗法 保乳术 预后 

分 类 号：R737.9[医药卫生—肿瘤]