T1-2N1M0期乳腺癌新辅助化疗后疗效分析及放疗选择的探讨

目的 评价T_1-2N₁M₀期乳腺癌新辅助化疗后辅助放疗对LC率的影响及地位。方法收集2005—2010年间收治的新辅助化疗患者资料,筛选出T_1-2N₁M₀人群,并对其辅助放疗的临床结果进行分析。共入组T_1-2N₁M₀患者144例,中位年龄45岁(23~72岁)。结果 术后30例(21%)获得乳腺原发灶和腋窝淋巴结pCR者均接受了辅助放疗,45例仅腋窝淋巴结阳性转阴性者中10例未接受辅助放疗,69例腋窝淋巴结转移仍为阳性者中6例未接受放疗,其余患者均接受了辅助放疗。全组中位随访时间88个月,46例复发转移(32%),其中pCR者5年LR率为3.0%。5年LR率新辅助化疗后腋窝淋巴结阳性转阴性者放疗组为7%、未放疗组为16%(P=0.181),腋窝淋巴结仍为阳性者放疗组为15.9%、未放疗组为33%(P=0.267)。全组pCR者DFS时间较非pCR者延长(P=0.017)。结论 新辅助化疗后获pCR者DFS期优于未获pCR者,获pCR患接受辅助放疗的LR率较低,腋窝淋巴结阳性转阴性者未能从术后辅助放疗中获益,而腋窝淋巴结转移仍为阳性者的LR率高,辅助放疗有获益趋势。

Disscussion and analysis of the effect of adjuvant radiotherapy after neoadjuvant chemotherapy for stage T1-2N1M0 breast cancer

Objective To evaluate the effects and significance of adjuvant radiotherapy after neoadjuvant chemotherapy on local recurrence (LR) rate in patients with stage T1-2N1M0 breast cancer.Methods Clinical data were collected from patients with stage T1-2N1M0 breast cancer who were admitted to our hospital and treated with neoadjuvant chemotherapy from 2005 to 2010.The clinical outcomes in those patients were analyzed after treatment with adjuvant radiotherapy.A total of 144 patients with a median age of 45 years (23-72 years) were enrolled as subjects.Results In the 144 patients,30 patients (21％) who had pathological complete response (pCR) in primary breast tumor and axillary lymph node received adjuvant radiotherapy;10 out of 45 patients who had pCR in axillary lymph node alone did not receive adjuvant radiotherapy;6 out of 69 patients who still had axillary lymph node metastasis after treatment did not receive adjuvant radiotherapy;all of the rest received adjuvant radiotherapy.In all patients,the median follow-up time was 88 months;46 patients (32％) had relapse and metastasis.The 5-year LR rate was 3.0％ in patients with pCR.In patients with pCR in axillary lymph node metastasis after neoadjuvant chemotherapy,there was no significant difference in the 5-year LR rate between patients treated with and without radiotherapy (7％ vs.16％,P=0.181).In patients with axillary lymph node metastasis after neoadjuvant chemotherapy,there was also no significant difference in the 5-year LR rate between patients treated with and without radiotherapy (15.9％ vs.33.3％,P =0.267).In all patients,those with pCR had significantly longer disease-free survival (DFS) time than those without pCR (P=0.017).Conclusions Patients with pCR to neoadjuvant chemotherapy have longer DFS time than those without pCR.The LR rate is relatively lower in patients with pCR undergoing adjuvant radiotherapy.Patients with pCR in axillary lymph node metastasis do not benefit from postoperative adjuvant radiotherapy.However,adjuvant radiotherapy is helpful in patients with axillary lymph metastasis after neoadiuvant chemotherapy who have high LR rates