早期乳腺癌根治术后辅助放疗指征探讨

目的 探讨腋窝淋巴结阳性数为1~3个的早期乳腺癌患者根治术后辅助放疗的指征。 方法 回顾性分析根治术后并经病理证实腋窝淋巴结阳性数为1~3个的早期乳腺癌患者92例，腋窝淋巴结阳性数为1、2、3个的患者数分别为40、30、22例。其中45例接受同侧胸壁、内乳区及锁骨上淋巴引流区放疗。定义预后指数≥4分者为高危患者， < 4分者为低危患者。采用Kaplan-Meier法计算生存率，并用Logrank法进行检验。 结果 放疗患者和未放疗患者的5年生存率分别为93.5%和86.4%(χ2=3.43，P＞0.05)，10年生存率分别为73.0%和56.8%(χ2=2.82，P＞0.05)，局部复发率为6.7%和19.1%(χ2=4.66，P＜0.05)。低危和高危患者中未放疗患者的10年生存率分别为73.0%和56.8%(χ2=3.45，P＞0.05)，局部复发率分别为11.0%和24.0%(χ2=4.64，P＜0.05)。低危和高危患者中接受放疗患者的10年生存率分别为82.0%和72.3%(χ2=4.07，P＜0.05)，局部复发率分别为11.0%和5.0%(χ2=5.64，P＜0.05)。 结论 对腋窝淋巴结阳性数为1~3个的早期乳腺癌根治术后且预后指数为高危的患者，建议术后行胸壁和同侧锁骨上淋巴结辅助放疗。

Indications for postmastectomy radiotherapy in early breast cancer patients

Objective To explore the indications for postmastectomy radiotherapy in early breast cancer patients with 1-3 positive axillary lymph nodes. Methods Ninety-two early breast cancer patients with 1-3 pathologically confirmed positive axillary lymph nodes after radical mastectomy were retrospectively analyzed. Of these patients, 45 received irradiation to the lateral chest wall, internal mammary chain and supraclavicular area. The prognostic index≥4 was considered as high-risk, while < 4 as the low-risk. Survival analysis was performed using the Kaplan-Meier method. The Log-rank test was used for the comparison of survival curves between different groups. Results The 5-year survival rates of patients with and without radiotherapy were 93.5% and 86.4%(χ2=3.43, P > 0.05), the 10-year survival rates were 73.0% and 56.8%(χ2=2.82, P > 0.05), the 10-year local recurrence rates were 6.7% and 19.1%(χ2=4.66, P < 0.05). The 10-year survival rates of patients with low risk and high risk without radiotherapy were 73.0% and 56.8%(χ2=3.45, P > 0.05), while the local recurrence rates were 11.0% and 24.0%(χ2=4.64, P < 0.05). The 10-year survival rates of patients with low risk and high risk with radiotherapy were 82.0% and 72.3%(χ2=4.07, P < 0.05), while the local recurrence rates were 11.0% and 5.0%(χ2=5.64, P < 0.05). Conclusion The early breast cancer patients with 1-3 positive axillary lymph nodes after radical mastectomy and the prognostic index suggests "high-risk" should receive irradiation to the chest wall and supraclavicular area.