1030例早期乳腺癌术后放疗不同年龄组的预后分析

目的 分析年龄与早期乳腺癌预后的关系.方法 回顾分析本院收治并有完整记录的1030例早期乳腺癌(腋窝阳性淋巴结数≤3个)患者临床资料,所有患者均经手术与病理检查,其中468例行保乳术(Ⅰ、Ⅱ期分别为227、241例),562例行改良根治术(I、Ⅱ期分别为184、378例).按年龄分为青年组(≤35岁,136例)、中年组(>35～≤60岁,738例)、老年组(>60岁,156例),其中肿瘤最大径>2.0 cm而未行放疗而仅行保乳术的分别为16、60、39例.放疗采用二维常规分割技术.比较不同年龄组肿瘤大小、腋窝淋巴结状态、受体情况及保乳术后放疗与预后关系.结果 总随访率为97.86%.总随访满5年者795例,其中青年组、中年组、老年组分别为110、569、116例,未放疗的青年组、中年组、老年组分别为40、202、87例.青年组、中年组、老年组5年复发率分别为6.2%、8.7%、10.4%(χ2=1.14,P=0.567),远处转移率分别为4.3%、9.5%、2.5%(χ2=5.31,P=0.070),生存率分别为91.2%、92.6%、82.1%(χ2=6.83,P=0.033).青年组肿瘤最大直径≤2.O cm者所占比例高(65.4%),腋窝淋巴结阳性率低(13.2%),组织分化差,激素受体阳性表达率低(48.0%).肿瘤最大直径>2.0cm未行放疗而仅行保乳术的青年组、中年组、老年组5年生存率分别为94%、87%、71%(χ2=20.69,P=0.000),复发率分别为23%、18%、7%(χ2=9.97,P=0.007),远处转移率分别为23%、25%、10%(χ2=8.51,P=O.014).结论 在早期乳腺癌中,年龄因素对保乳术患者预后有重要影响趋势,对改良根治术患者影响不明显.

The prognostic value of age for 1030 patients with early stage breast cancer after postoperative radiotherapy

Objective To analyze the prognostic value of age in patients with early stage breast cancer. Methods The clinical characteristics of 1030 patients with early stage breast cancer (the number of positive axillary lymph nodes was less than 3) were retrospectively reviewed. Of all the patients, 468(stage Ⅰ, n = 227; and stage Ⅱ , n = 241) received breast conserving surgery (BCS) and 562 (stage Ⅰ, n =184; and stage Ⅱ, n= 378) received modified mastectomy. Patients were divided into young-age group (≤35,136 patients), middle-age group (> 35-≤60,738 patients) and old-age group (> 60,156 patients).The number of patients without postoperative radiation therapy after BCS is 16, 60 and 39 in the three groups, respectively. Two-dimensional conventional fractionated radiotherapy was administered. The prognostic value of the tumor size, status of axillary lymph nodes or hormonal receptors, postoperative radiation therapy were analyzed. Results The follow-up rate was 97.86%. Of 795 patients followed up more than 5 years, 110,569 and 116 patients were devided into the three groups, respectively. There were 40, 202 and 87 patients without radiation therapy in the three groups. The 5-year recurrence rates of the three groups were 6. 2%, 8. 7% and 10. 4% (χ2 = 1.14, P= 0.567). The 5-year distant metastasis rates were4.3% , 9.5 % and2. 5% (χ2 = 5.31 , P = 0. 070) . The5 - year survival rates were9l. 2% , 92. 6%and 82. 1% (χ2 = 6. 83, P = 0.033). The young-age group had more tumors smaller than 2. 0 cm (65.4%), less positive axillary lymph nodes (13.2%), poorer differential tumor and less positive hormone acceptors (48.0%). Of patients with tumor larger than 2. 0 cm who had no radiotherapy after BCS, the 5-year survival rates were 94%, 87% and 71% (χ2= 20.69, P= 0.000) in the three groups. The corresponding recurrence rates were 23%, 18% ,7%, (χ2 = 9. 97, P = 0. 007), and distant metastasis rates were23%, 25% and 10% (χ2 =8.51, P=0. 014). Conclusions The age is an important prognostic factor in patients with early stage breast cancer undergoing BCS, but not in those undergoing modified mastectomy.