改良根治术后pT_(1-2)N_(1)期乳腺癌的局部区域复发部位——12个中心5442例患者的联合分析  

Local recurrence pattern of pT_(1-2)N_(1) breast cancer after modified radical mastectomy——a pooled-analysis of 5442 patients from 12 centers

作　　者：郭新园 张玉晶 张娜[3] 唐玉 赵旭冉 景灏 房辉 温戈 程晶[5] 石梅 郭启帅 吴洪芬 王小虎[9] 马常英[10] 李晔雄[1] 王宏梅 刘敏[12] 王淑莲[1] Guo Xinyuan;Zhang Yujing;Zhang Na;Tang Yu;Zhao Xuran;Jing Hao;Fang Hui;Wen Ge;Cheng Jing;Shi Mei;Guo Qishuai;Wu Hongfen;Wang Xiaohu;Ma Changying;Li Yexiong;Wang Hongmei;Liu Min;Wang Shulian(Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Radiation Oncology,First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Department of Radiation Oncology,Liaoning Cancer Hospital,Shenyang 110801,China;Department of Radiation Oncology,The Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China;Department of Breast Oncology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Radiation Oncology,Xijing Hospital,Affiliated to Air Force Military Medical University,Xi'an 710032,China;Department of Radiation Oncology,Affiliated Cancer Hospital of Chongqing University,Chongqing 400030,China;Department of Radiation Oncology,Jilin Cancer Hospital,Changchun 130012,China;Department of Radiation Oncology,Gansu Cancer Hospital,Lanzhou 730050,China;Department of Radiation Oncology,Qiqihar First Hospital,Qiqihar 161055,China;Department of Radiation Oncology,First School of Clinical Medicine,Southern Medical University,Guangzhou 510515,China;Department of Radiation Oncology,First Hospital of Jilin University,Changchun 130061,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,北京100021 [2]中山大学附属第一医院放疗科,广州510080 [3]辽宁省肿瘤医院放疗科,沈阳110042 [4]广州医科大学附属第三医院肿瘤放疗科,广州510150 [5]华中科技大学同济医学院附属同济医院肿瘤科,武汉430030 [6]西京医院放疗科,西安710032 [7]重庆大学附属肿瘤医院/重庆市肿瘤医院放疗科,重庆400030 [8]吉林省肿瘤医院放疗科,长春130012 [9]甘肃省肿瘤医院/甘肃省医学科学研究院放疗科,兰州730050 [10]齐齐哈尔市第一医院放疗科,齐齐哈尔161005 [11]南方医科大学第一临床医院/南方医院放疗科,广州510515 [12]吉林大学白求恩第一医院放疗科,长春130061

出　　处：《中华放射肿瘤学杂志》2022年第3期248-252,共5页Chinese Journal of Radiation Oncology

基　　金：中国医学科学院医学与健康科技创新工程(2020-I2M-C&T-B-075);国家自然科学基金(81972860);广东省医学科研基金(B2020065)

摘　　要：目的分析改良根治术后pT_(1-2)N_(1)期乳腺癌患者的局部区域复发(LRR)部位及放疗对复发的影响。方法收集中国12家医院符合条件的5442例乳腺癌患者资料,分析放疗和未放疗患者的LRR部位及不同部位放疗对复发的影响。采用Kaplan-Meier法计算LRR率并log-rank法检验。结果全组中位随访63.8个月,395例患者出现LRR。无论辅助放疗与否和不同分子分型,胸壁和锁骨上区均为最常见的LRR部位。全组胸壁照射和未照射患者的5年胸壁复发率分别为2.5%和3.8%(P=0.003);锁骨上区照射和未照射患者的5年锁骨上淋巴结复发率分别为1.3%和4.1%(P<0.001);腋窝照射和未照射患者的5年无腋窝复发率分别为0.8%和1.5%(HR=0.31,95%CI为0.04~2.23,P=0.219);内乳照射和未照射患者的5年无内乳复发率分别为0.8%和1.5%(HR=0.45,95%CI为0.11~1.90,P=0.268)。结论改良根治术后pT_(1-2)N_(1)期乳腺癌患者的主要LRR部位是胸壁和锁骨上区,不受辅助放疗与否和分子分型的影响。胸壁和锁骨上区放疗显著降低相应部位的复发风险,而腋窝和内乳放疗未降低相应部位的复发风险。Objective To analyze locoregional recurrence(LRR)pattern of patients with pT_(1-2)N_(1) breast cancer after modified radical mastectomy,with and without adjuvant radiotherapy(RT).Methods A total of 5442 eligible patients with breast cancer from 12 Chinese centers were included.The LRR sites and the effect of RT at different sites on recurrence in patients with and without RT were analyzed.The Kaplan-Meier method was used to calculate the cumulative LRR rate,and the difference was compared by the log-rank test.Results With a median follow-up time of 63.8 months for the entire cohort,395 patients developed LRR.The chest wall and supraclavicular fossa were the most common LRR sites,regardless of RT or molecular subtypes.The 5-year chest wall recurrence rates for patients with and without chest wall irradiation were 2.5% and 3.8%(P=0.003);the 5-year supraclavicular lymph nodal recurrence rates for patients with and without supraclavicular fossa irradiation were 1.3% and 4.1%(P<0.001);the 5-year axillary recurrence-free rates for patients with and without axillary irradiation were 0.8% and 1.5%(HR=0.31,95%CI:0.04-2.23,P=0.219);and the 5-year internal mammary nodal recurrence-free rates for patients with and without internal mammary nodal irradiation were 0.8% and 1.5%(HR=0.45,95%CI:0.11-1.90,P=0.268).Conclusions The chest wall and supraclavicular fossa are the most common LRR sites of patients with pT_(1-2)N_(1) breast cancer after modified radical mastectomy,which is not affected by adjuvant RT or molecular subtypes.The chest wall and supraclavicular fossa irradiation significantly reduce the risk of recurrence in the corresponding area.However,axillary and internal mammary nodal irradiation has no impact on the risk of recurrence in the corresponding area.

关 键 词：乳腺肿瘤/改良根治术 乳腺肿瘤/术后放疗 局部区域复发 阳性淋巴结 

分 类 号：R737.9[医药卫生—肿瘤]