T1～T2期伴1～3个腋窝淋巴结转移乳腺癌患者改良根治术后放疗的作用

摘要

目的 回顾性分析370例T1～T2期、腋窝淋巴结转移数为1～3个乳腺癌患者改良根治术后的治疗结果,探讨放疗的作用.方法 用Kaplan-Meier法计算生存率,分析放疗对生存率和复发率的影响,同时分析对未放疗患者复发率有影响的临床病理因素.结果 中位随访时间为50个月(9～91个月).全组患者的5年无局部区域复发率为91.0%,总生存率为85.4%.放疗显著提高5年无局部区域复发生存率(100%和89.5%;x2=5.17,P=0.023),对总生存率无影响.对319例未行放疗患者的单因素分析显示T分期、腋窝淋巴结阳性数、C-erbB-2和PR状态是预测无复发生存率的有意义因素.结论 T1～T2期且腋窝淋巴结转移数1～3个乳腺癌患者改良根治术后,放疗显著降低局部复发率,但对总生存率无影响.T分期、腋窝淋巴结阳性数、C-erbB-2和PR状态是预测元复发生存率的有意义因素.%Objective To analyze the outcomes and the role of radiotherapy in breast cancer pa-tients with T1-T2 and one to three positive axillary nodes treated with modified radical mastectomy, and to investigate the prognostic factors for loco - regional recurrence in patients without radiotherapy . Methods Three hundred and seventy breast cancer patients with T1-T2 and one to three positive axillary lymph nodes treated with mastectomy and axillary dissection were retrospectively analyzed. Kaplan-Meier method was used to calculate the overall survival (OS) and loco-regional recurrence-free survival (LRFS) rates. The Logrank test was used for the comparison of the survival curves of patients with or without radiotherapy. Univariate analyses of potential prognostic variables for LRFS were performed. Results The 5-year OS and LRFS rates were 85.4% and 91%. Radiotherapy significantly improved the 5-year LRFS rate ( 100% vs. 89.5% ;x2 = 5.17, P=0.023). However, there was no significant difference in overall survival rate between patients with and without radiotherapy. In univariate analyses, T stage, the number of positive axillary nodes, C-erbB-2 and PR status were the significant predictive factors for LRFS. Conclusions For breast cancer pa-tients with T1-T2. and one to three positive axillary nodes, radiotherapy improves the LRFS, but not OS. T stage, the number of positive axillary nodes, C-erbB-2 and PR status are predictive factors for loco-regional recurrence in patients without radiotherapy.