皮肤受侵非炎性和炎性乳腺癌的放疗结果

目的 分析现有放疗技术和剂量对皮肤受侵乳腺癌的控制作用.方法 回顾分析53例改良根治术后病理证实为乳腺浸润癌患者资料.其中炎性乳腺癌10例,非炎性乳腺癌43例.非炎性乳腺癌中临床皮肤受侵19例,病理诊断皮肤受侵24例.30例原发肿瘤最大径≤5 cm,13例>5 cm.全组33例接受术后放疗,中位剂量50 Gy,胸壁硅胶填充的6例20 Gy、21例>20 Gy,6例不详.45例行化疗.结果 随访率87%.全组5年局部区域复发率(LRR)、无瘤生存率(DFS)和总生存率(OS)分别为18%、45%和64%.非炎性乳腺癌比炎性乳腺癌有较高的5年DFS(49%:30%;χ2=4.29,P=0.038)和OS(71%:37%;χ2=5.92,P=0.015).非炎性乳腺癌中肿瘤≤5 cm比>5 cm患者有较低的5年LRR(11%:33%;χ2=3.75,P=0.053)和较高的5年OS(90%:38%;x24.44,P=0.035);临床诊断和单纯病理诊断皮肤受侵患者的局部区域复发率、DFS和OS相似.腋窝淋巴结0～3个阳性比≥4个阳性患者有较高的5年DFS(80%:29%;χ2=6.71,P=0.010)和OS(93%:52%;χ2=6.00,P=0.014).Rec+/Her2-比三阴或Her2+患者有较低的5年LRR(7%:34%;χ2=5.70,P=0.017)和较高DFS(54%:32%;χ2=8.82,P=0.003).放疗和未放疗患者的5年LRR分别为12%和30%(χ2=2.45,P=0.118).但放疗患者胸壁硅胶填充剂量>20 Gy和20 Gy患者的5年胸壁复发率为0%和50%(χ2=9.15,P=0.002).结论 皮肤受侵乳腺癌是一组异质性很强的患者,非炎性乳腺癌、原发肿瘤≤5 cm、腋窝淋巴结0～3个阳性和rec+/Her2-患者预后较好.临床诊断和病理诊断皮肤受侵患者的预后无差别.为降低胸壁复发率,胸壁放疗硅胶填充剂量应>20 Gy.

Prognostic factors for skin-involved inflammatory and non-inflammatory breast cancer

Objective To analyze the prognostic factors and the role of postmastectomy radiotherapy (PMRT) in skin-involved breast cancer.Methods Fifty-three skin-involved breast cancer patients treated with mastectomy and axillary dissection were retrospectively analyzed.Ten patients had inflammatory breast cancer (IBC).Of the 43 non-inflammatory breast cancer (NIBC) patients, 19(36%) had clinical signs of skin involvement and 24(45%) had pathological skin infiltration without clinical signs.Thirty-three patients (62%) received PMRT with a median dose of 50 Gy, 45 received chemotherapy and 27 received hormone therapy.Results The median follow up time for alive patients was 42 (7 -83) months.The overall 5-year locoregional recurrence (LRR),disease-free survival (DFS) and overall survival (OS) rates were 18%,45% and 64%.Patients with NIBC had a significantly better 5-year DFS (49% vs.30% ,χ2=4.29,P=0.038) and OS (71% vs.37% ,χ2=5.92,P=0.015) than those with IBC.In patients with NIBC, those with primary tumor ≤5 cm had a lower 5-year LRR (11% vs.33% ,χ2= 3.75 ,P =0.053) and a higher 5-year OS (90% vs.38% ,χ2=4.44,P=0.035) as compared to those >5 cm.No significant difference in terms of LRR, DFS or OS was observed between patients with clinical signs of skin involvement and those without.Patients with 0 - 3 positive nodes had an improved 5-year DFS (80% vs.29%, χ2= 6.71, P =0.010) and OS (93% vs.52% ,χ2=6.00,P=0.014) than those with ≥4 positive nodes.Patients with Rec + / Her2 - had a lower5 - year LRR (7 % vs.3 4 % , χ2= 5.70, P= 0.017) and a higher DFS (54% vs.32% ,χ2=8.82 ,P =0.003) than those with triple-negative or Her2 +.There was no significant difference in 5-year LRR (12% vs.30%, χ2= 2.45, P = 0.118) between patients with PMRT and without PMRT.However, the 5-year chest wall recurrence rate was 0% and 50% (χ2= 9.15 ,P =0.002) for patients with chest wall bolus dose > 20 Gy and 20 Gy.Conclusions Skin-involved breast cancer is a heterogeneous group of diseases.Patients with NIBC, small tumor (≤5 cm), less positive nodes (0 -3) or rec +/Her2-have favorable prognosis.Patients with pathologically proven skin involvement without clinical signs have similar prognosis to those with clinical signs.PMRT with chest wall bolus dose >20 Gy is recommended.