早期乳腺癌患者保乳术后行大分割同步瘤床补量放疗致皮肤放射性损伤的影响因素分析  

Influencing factors of radiation-induced skin injury induced by hypofractionated radiotherapy with simultaneous integrated boost for early breast cancer patients after breast-conserving surgery

作　　者：邵瑞雨 王建廷[1] 王晓红[1] SHAO Ruiyu;WANG Jianting;WANG Xiaohong(Six Department of Radiochemotherapy,Tangshan People’s Hospital,Tangshan 063001,China)

机构地区：[1]唐山市人民医院放化六科,河北唐山063001

出　　处：《新医学》2025年第1期60-65,共6页Journal of New Medicine

基　　金：河北省卫生健康委科研基金项目(20211663)。

摘　　要：目的分析早期乳腺癌患者保乳术后行大分割同步瘤床补量放疗致皮肤放射性损伤的影响因素。方法回顾性分析2021年6月至2023年6唐山市人民医院收治的182例早期乳腺癌保乳术后行大分割同步瘤床补量放疗患者的病历资料,根据放射性皮炎严重程度分为对照(0度)组60例、轻度(1~2度)组62例、重度(≥3度)组60例,对比分析3组患者临床资料,采用多因素Logistic回归分析皮肤放射性损伤的影响因素。结果3组患者的年龄、月经情况、肿瘤标志物水平、病理分度、卡培他滨用药情况、CD3+T及CD8+T胞凋亡率无统计学差异(均P>0.05);轻度组和重度组患者体质量指数(BMI)≥28 kg/m^(2)、T2分期、三阴性乳腺癌比例及CD4+T细胞凋亡率高于对照组,且重度组高于轻度组(均P<0.05)。多因素Logistic回归分析结果显示,BMI≥28 kg/m^(2)[OR(95%CI)=2.413(1.206~4.829)]、肿瘤分期为T2期[OR(95%CI)=3.830(1.768~8.296)]、三阴性乳腺癌[OR(95%CI)=2.399(1.188~4.844)]及CD4+T淋巴细胞凋亡率[OR(95%CI)=1.526(1.218~1.912)]是放射性皮肤损伤的危险因素(均P<0.05)。结论在乳腺癌大分割瘤床同步补量放疗的患者中,BMI、T分期、CD4+T细胞凋亡率及三阴性乳腺癌是皮肤放射性损伤的主要危险因素,可影响其放射性皮肤损伤程度。Objective To analyze the influencing factors of radiation-induced skin injury induced by hypofractionated radiotherapy with simultaneous integrated boost in patients with early breast cancer after breast-conserving surgery.Methods Medical records of 182 patients with early breast cancer who were treated with hypofractionated radiotherapy with simultaneous integrated boost after breast-conserving surgery in Tangshan People’s Hospital from June 2021 to June 2023 were retrospectively analyzed.According to the severity of radiation dermatitis,they were divided into the control group(0 degree,n=60),mild group(1-2 degree,n=62),and severe group(≥3 degree,n=60).Clinical data of patients among three groups were compared.The influencing factors of radiation-induced skin injury were identified by multivariate Logistic regression analysis.Results There were no statistically significant differences in age,menstrual status,tumor marker levels,pathological grading,capecitabine use,CD3+T and CD8+T cell apoptosis rates among three groups(all P>0.05).The proportion of patients with body mass index(BMI)≥28 kg/m^(2),T2 stage,triple-negative breast cancer and CD4+T cell apoptosis rate in the mild and severe groups were higher than those in the control group,and the data in the severe group were higher than those in the mild group(all P<0.05).Multivariate Logistic regression analysis showed that BMI≥28 kg/m^(2)[OR(95%CI)=2.413(1.206-4.829)],tumor stage T2[OR(95%CI)=3.830(1.768-8.296)],triple-negative breast cancer[OR(95%CI)=2.399(1.188-4.844)]and CD4+T lymphocyte apoptosis rate[OR(95%CI)=1.526(1.218-1.912)]were the risk factors for radiation-induced skin injury(all P<0.05).Conclusion BMI,T stage,CD4+T cell apoptosis rate and triple-negative breast cancer are the main risk factors of radiation-induced skin injury in patients with early breast cancer undergoing hypofractionated radiotherapy with simultaneous integrated boost after breast-conserving surgery,which can affect the degree of radiation-induced skin injury.

关 键 词：早期乳腺癌 保乳术 全乳放疗 大分割放疗 同步瘤床补量 

分 类 号：R737.9[医药卫生—肿瘤]