放射治疗对乳腺癌寡转移局部控制的影响  

Influence of radiotherapy intervention on local control of oligometastatic breast cancer

作　　者：王淑伟 殷进军[1] 邵姜超 丛秋梅 王冰[4] Wang Shuwei;Yin Jinjun;Shao Jiangchao;Cong Qiumei;Wang Bing(Second Department of Radiotherapy,Weihai Municipal Hospital,Shandong University,Weihai 264200,China;Science and Education Section,Weihai Municipal Hospital,Shandong University,Weihai 264200,China;First Department of Oncology,Weihai Central Hospital,Weihai 264400,China;Department of Pharmacy,Weihai Municipal Hospital,Shandong University,Weihai 264200,China)

机构地区：[1]山东大学附属威海市立医院放射治疗二科,264200 [2]山东大学附属威海市立医院科教科,264200 [3]威海市中心医院肿瘤一科,264400 [4]山东大学附属威海市立医院药剂科,264200

出　　处：《中华乳腺病杂志（电子版）》2023年第2期72-79,共8页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：山东省老年医学学会2021年度科技攻关计划项目(LKJGG2021W123)。

摘　　要：目的探讨放射治疗对乳腺癌寡转移患者的预后的影响。方法回顾性分析2013年1月1日至2017年6月30日山东大学附属威海市立医院收治的75例乳腺癌术后寡转移患者的临床资料,采用调强/三维适形放射治疗技术对寡转移部位进行放射治疗,生存分析采用Kaplan-Meier法,组间差异比较采用Log-rank检验。全病变放射治疗组及非全病变放射治疗组临床病理特征比较采用χ^(2)检验或Fisher确切概率法。多因素分析采用Cox回归法。结果75例乳腺癌寡转移患者中,采用调强放射治疗68例,三维适形放射治疗7例;放射治疗部位骨30例,肺22例,淋巴结19例,脑转移3例,肝转移1例。中位随访时间为42.0个月(32.0~52.0个月),5年0S为65.4%,5年无进展生存率(PFS)为68.6%,5年局部控制率为64.4%。全病变放射治疗组50例,非全病变放射治疗组25例。全病变放射治疗组预后优于非全病变放射治疗组(5年PFS:88.9%比22.0%,χ^(2)=17.381,P<0.001;5年0S:82.5%比22.7%,χ^(2)=15.416,P<0.001;5年局部控制率:87.3%比24.0%,χ^(2)=15.669,P<0.001)。接受不同部.位放射治疗的患者5年局部控制率.OS及PFS比较,差异均无统计学意义(χ^(2)=2.462、2.717、0.929,P=0.482、0.437、0.818)。多因素分析显示:全病变放射治疗、组织学分级2级是乳腺癌寡转移患者局部控制率(HR=0.115,95%CI:0.037~0.363,P<0.001;HR=0.138,95%CI:0.029-0.651,P=0.012)、PFS(HR=0.127,95%CI:O.041~0.392,P<0.001;HR=0.150,95%CI:0.034~0.661,P=0.012)、OS(HR=0.144,95%CI:0.047~0.441,P=0.001;HR=0.169,95%CI:0.038~0.754,P=0.020)的独立保护因素;肿块直径<3 cm是局部控制率的独立保护因素(HR=0.265,95%CI:0.092~0.764,P=0.014)。结论乳腺癌寡转移全病变放射治疗可以改善患者预后,尤其是对于组织学分级2级和肿块直径<3cm的患者,可以提高其局部控制率。Objective To investigate the effect of radiotherapy on the local control of oligometastatic breast cancer.Methods A retrospective analysis was performed on the clinical records of 75 patients with oligometastatic breast cancer after surgery in the Weihai Municipal Hospital,Shandong University from January 1,2013 to June 30,2017.All patients underwent intensity modulated radiotherapy or 3D conformal radiotherapy on oligometastatic sites.The Kaplan-Meier method was used for survival analysis and the log-rank test was used for group comparison.X?test or Fisher exact text was used to compare clinicopathologic features between the whole lesion radiotherapy group and the non-whole lesion radiotherapy group.The Cox regression was used for multivariate analysis.Results Intensity modulated radiotherapy was used in 68 cases and 3D conformal radiotherapy was used in 7 cases.The radiation sites were listed as follow:bone in 30 cases,lung in 22 cases,lymph nodes in 19 cases,brain in 3 cases and liver in one case.The median follow-up was 42.0 months(range:32.0-52.0 months).The 5-year OS,progression-free survival(PFS)and local control rate(LC)was 65.4%,68.6%and 64.4%,respectively.Totally 50 cases received the whole lesion radiotherapy and other 25 cases received non-whole lesion radiotherapy.The prognosis of patients in the whole lesion radiotherapy group was significantly better than that in the non-whole lesion radiotherapy group(5-year PFS:88.9%vs 22.0%,χ^(2)=17.381,P<0.001;5-year 0S:82.5%us 22.7%,χ^(2)=15.416,P<0.001;5-year LC:87.3%us 24.0%,χ^(2)=15.669,P<0.001).There were no significant differences in the 5-year LC,OS and PFS between patients receiving radiotherapy on different sites.Multivariate analysis showed that whole lesion radiotherapy and histological grade 2 were independent protective factors for LC(HR=0.115,95%CI:0.037-0.363,P<0.001;HR=0.138,95%CI:0.029-0.651,P=0.012),PFS(HR=0.127,95%CI:0.041-0.392,P<0.001;HR=0.150,95%CI:0.034-0.661,P=0.012)and 0S(HR=0.144,95%CI:0.047-0.441,P=0.001;HR=0.169,95%CI:0.038-0.754,

关 键 词：乳腺肿瘤 放射疗法 寡转移 局部控制率 

分 类 号：R737.9[医药卫生—肿瘤]