全乳放疗在70岁以上老年乳腺癌预后中的临床价值分析  

Clinical Value Analysis of Whole-breast Radiotherapy in the Prognosis of Women Aged 70 Years or Older with Breast Cancer

作　　者：夏坤健 唐娜 李顶 XIA Kunjian;TANG Na;LI Ding(Department of General Surgery,The Second Affiliated Hospital of Jiujiang College,Jiujiang 332005,China;Department of Breast Surgery,The Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]九江学院第二附属医院普通外科,江西九江332005 [2]南昌大学第二附属医院乳腺外科,江西南昌330006

出　　处：《中山大学学报(医学科学版)》2025年第2期335-344,共10页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：江西省卫生健康委科技计划(SKJP220211021)。

摘　　要：【目的】探讨放疗在≥70岁老年乳腺癌预后中的临床价值。【方法】以南昌大学第二附属医院2011年2月28日—2021年2月28日收治的311例≥70岁接受保乳手术的老年乳腺癌为研究对象,分为183例对照组(接受术后放疗)与128例病例组(未接受术后放疗)。采用Mann-Whitney U非参数检验或χ^(2)检验比较两组患者的一般临床病理资料,采用Kaplan-Meier法对两组患者的无病生存期(DFS)及总生存期(OS)进行分析并进行log-rank检验,采用多因素Cox比例风险回归模型分析≥70岁老年乳腺癌DFS及OS影响因素,最后进行亚组分析。【结果】对照组与病例组患者间的年龄、肿瘤T分期、肿瘤N分期、肿瘤临床分期、雌激素受体(ER)状态、孕激素受体(PR)状态、人表皮生长因子受体2(HER2)状态、Ki-67指数、肿瘤组织学分级、肿瘤病理类型、是否接受辅助化疗、是否接受术后内分泌治疗的差异均无统计学意义(P均>0.05)。对照组与病例组的中位随访时间分别为110.0(95%CI:98.9,121.1)个月与93.0(95%CI:86.1,100.0)个月,两组间DFS率的差异具有统计学意义(92.9%vs.85.2%,P=0.024),两组间OS率的差异无统计学意义(92.3%vs.88.3%,P=0.199)。多因素Cox比例风险回归模型分析显示,肿瘤T分期、肿瘤N分期(N2及N3)、HER2状态、Ki-67、肿瘤组织学分级(Ⅱ、Ⅲ级)、未接受放疗均为老年乳腺癌患者DFS的独立危险因素(P均<0.05),ER状态为老年乳腺癌患者DFS的独立保护因素(P<0.05),肿瘤分期、肿瘤N分期(N2及N3)、HER2状态、Ki-67均为老年乳腺癌患者OS的独立危险因素(P均<0.05),ER状态为老年乳腺癌患者OS的独立保护因素(P<0.05)。亚组分析显示,在激素受体(hormone receptor,HR)阴性老年乳腺癌患者中,对照组与病例组的中位随访时间分别为123.0(95%CI:116.8,129.2)个月与88.0(95%CI:75.2,100.8)个月,两组间DFS率的差异具有统计学意义(91.3%vs.68.6%,P=0.008),两组间OS率的差异亦具有统计�【Objective】To investigate the prognostic role of radiotherapy in women aged 70 years or older with breast cancer.【Methods】A total of 311 women aged 70 years or older with breast cancer undergoing breast-conserving surgery in the Second Affiliated Hospital of Nanchang University between February 28,2011 and February 28,2021,were divided into two groups:183 patients in the control group were given postoperative radiotherapy,and 128 patients in the case group were not treated by radiotherapy.The nonparametric Mann-Whitney U test or χ^(2) test was used to compare the general clinicopathological data of the two groups,the Kaplan-Meier method and log-rank test to analyze the disease-free survival(DFS)and overall survival(OS),multivariate Cox proportional hazards regression model to examine the factors affecting DFS and OS.Additional subgroup analysis was performed.【Results】There were no statistically significant differences between the control and case groups in age,T-stage,N-stage,tumor clinical stage,estrogen receptor(ER),progesterone receptor(PR)and human epidermal growth factor receptor type 2(HER 2)statuses,Ki-67,tumor histological grade,tumor pathological type,and whether they received adjuvant chemotherapy or postoperative endocrine therapy(all P>0.05).The median follow-up was 110.0(95%CI:98.9,121.1)months for the control group and 93.0(95%CI:86.1,100.0)months for the case group.Differences between the two groups in DFS rate were significant(92.9%vs.85.2%,P=0.024),but in OS rate insignificant(92.3%vs.88.3%,P=0.199).Multivariate Cox proportional hazards regression analysis showed that T-stage,N-stage(N 2 and N 3),HER 2 status,Ki-67,tumor histological grade(gradeⅡandⅢ),and no radiotherapy were independent risk factors for DFS in elderly breast cancer patients(all P<0.05),while ER status was an independent protective factor(P<0.05).The independent risk factors for OS in elderly breast cancer patients included tumor stage,N-stage(N 2 and N 3),HER 2 status,and Ki-67(all P<0.05),and ER status was an i

关 键 词：老年乳腺癌 保乳手术 放疗 无病生存期 总生存期 

分 类 号：R473.59[医药卫生—护理学]