乳腺癌同侧锁骨上淋巴结转移患者行手术联合放射治疗的预后分析  

Prognosis of breast cancer patients with ipsilateral supraclavicular lymph node metastasis treated by surgery combined with radiotherapy

作　　者：李晓红 张安度[1] 韩慧娜 孔德友[1] 张舰[1] 段学娟 孔洁[1] 曲福印 杜凯邺 张钧[1] 刘志坤[1] Li Xiaohong;Zhang Andu;Han Huina;Kong Deyou;Zhang Jian;Duan Xuejuan;Kong Jie;Qu Fuyin;Du Kaiye;Zhang Jun;Liu Zhikun(Department of Radiotherapy,Fourth Hospital of Hebei Medical University,Shjiashuang 050035,China)

机构地区：[1]河北医科大学第四医院东院放射治疗科,石家庄050035

出　　处：《中华乳腺病杂志（电子版）》2022年第1期14-22,共9页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：目的:探讨乳腺癌同侧锁骨上淋巴结转移患者行锁骨上淋巴结清扫术联合放射治疗的预后影响因素。方法:回顾性分析2009年12月至2015年3月河北医科大学第四医院收治的68例同时型同侧锁骨上淋巴结转移(sISLM)的乳腺癌患者临床资料。患者锁骨上转移淋巴结的局部治疗模式均为淋巴结清扫术联合放射治疗。主要研究指标为患者无局部区域复发生存(LRFS)、无远处转移生存(DMFS)、无进展生存(PFS)和OS。单因素生存分析采用Kaplan-Meier法、Log-rank检验,多因素生存分析采用Cox比例风险回归模型。结果:中位随访92个月(58~122个月),患者5年LRFS、DMFS、PFS、OS率分别为79.2%、65.8%、55.8%和64.7%。多因素生存分析发现:腋窝淋巴结转移数目≥10枚是患者5年DMFS的危险因素(与无腋窝淋巴结转移者相比,HR=8.151,95%CI:1.011~65.726,P=0.049);Ki-67>30%、锁骨上淋巴结清扫数目≥10枚、锁骨上淋巴结转移数目≥2枚是患者5年PFS的危险因素(HR=6.674,95%CI:2.291~19.443,P=0.001;HR=2.605,95%CI:1.039~6.528,P=0.041;HR=2.958,95%CI:1.155~7.577,P=0.024)。进一步分析发现:当锁骨上淋巴结清扫数目<10枚时,锁骨上区放射治疗剂量50 Gy组与>50 Gy组相比,患者5年LRFS、DMFS、PFS、OS率的差异均无统计学意义(χ^(2)=0.117、1.735、2.754、3.073,P均>0.050);当锁骨上淋巴结清扫数目≥10枚时,锁骨上区放射治疗剂量>50 Gy组5年DMFS率却低于50 Gy组(χ^(2)=4.808,P=0.028)。结论:对于乳腺癌同侧锁骨上淋巴结转移患者而言,锁骨上淋巴结清扫数目≥10枚、锁骨上淋巴结转移数目≥2枚者其PFS更差,提高锁骨上区放射治疗剂量并不能改善患者的预后。Objective To explore the prognostie factors for breast cancer patients with ipsilateral supraclavicular lymph node metastasis receiving surgical dissection of supraclavicular lymph nodes combined with radiotherapy.Methods The clinical data of 68 breast cancer patients with synchronous ipsilateral supraclavicular lymph node metastasis in the Department of Radiotherapy,Fourth Hospital of Hebei Medical University from December 2009 to March 2015 were retrospectively analyzed.The local treatment of metastatic supraclavicular lymph node was supraclavicular lymph nodes dissection combined with radiotherapy in all patients.The main indicators were looregional recurence-free survival(LRFS),distant metastasis-free suvival(DMFS),progression-free survival(PFS)and 0S.The Kaplan-Meier method and Log-rank test were used for univariate analysis.The Cox proportional hazard regression model was used for multivariate analysis.Results The median follow-up was 92 months(58-122 months).The 5-year LRFS,DMFS,PFS and 0S rate of all patients were 79.2%,65.8%,55.8%and 64.7%,respectively.Multivariate analysis found that the number of metastatic axillary lymph nodes≥10 was a risk factor for 5-year DMFS(compared with patients with no aillary lymph node metastasis:HR=8.151,95%CI:1.011-65.726,P=0.049);Ki-67>30%,number of dissected supraclavicular lymph nodes≥10 and number of metastatic supraclavicular lymph nodes≥2 were risk factors for 5-year PFS(HR:6.674,95%CI:2.291-19.443,P=0.001;HR:2.605,95%CI:1.039-6.528,P=0.041;HR:2.958,95%CI:1.155-7.577,P=0024).If the number of dissected supraclavicular lymph nodes was less than 10,no significant diference was found in 5-year LRFS,DMFS,PFS and 0S rate between patients receiving supraclavicular radiotherapy dose of 50 Gy and patients receiving supraclavicular radiotherapy dose>50 Gy(x=0.117,1.735,2.754.3.073,ll P>0.050).If the number of dissected supraclavicular lymph nodes was no less than I 0,the patients receiving supraclavicular radiotherapy dose of 50 Gy had a significantly higher 5-year DMFS

关 键 词：乳腺肿瘤 锁骨 淋巴结切除术 肿瘤转移 放射疗法 预后 

分 类 号：R737.9[医药卫生—肿瘤]