T1~2期伴1~3个腋窝淋巴结转移术后未行放射治疗乳腺癌患者的局部复发风险及生存分析

目的 通过对 1~3个腋窝淋巴结（ALNs）阳性早期乳腺癌患者的分子分型与局部复发及预后相关性进行探讨，为进一步完善术后放射治（PMRT）的个体化适应证提供参考。方法 回顾性分析2009—2012年我院就诊的489例未行PMRT的pT1~2N1M0（1~3个ALNs阳性）患者。采用Kaplan-Meier法计算局部复发率（LRR）、无病生存率（DFS）和总生存率（OS），采用Log-rank检验和Cox回归模型确定影响不同分子分型患者LRR及与预后的临床病理因素。结果 489例未行PMRT的pT1~2N1M0乳腺癌患者中Luminal A型、Luminal B（HER-2阴性）型和三阴型分别为229、196和 64例。中位随访时间为 75个月（5~115个月），对分子分型进行亚组分析显示，三阴型 5年 LRR高于非三阴型，5年DFS和OS均低于非三阴型，差异有统计学意义（均P＜0.05）。然而，在Luminal A型和Luminal B（HER-2阴性）型之间5年LRR、DFS和OS差异均无统计学意义（均P＞0.05）。多因素Cox回归分析表明年龄≤35岁、pT2分期和三阴型是LRR的独立不良预后因素。结论 分子分型有助于个体化区别伴1~3个ALNs转移的pT1~2N1M0乳腺癌患者的局部复发风险，对于LRR较高的年龄≤35岁、pT2分期及三阴型乳腺癌患者推荐行PMRT以改善预后。

Local recurrence risk and survival analysis of breast cancer patients with T1-2 and one to three positive axillary lymph nodes without postmastectomy radiotherapy

Objective To investigate the relationship between molecular subtype and local recurrence and prognosis inpatients with early-stage breast cancer and 1-3 positive axillary lymph nodes (ALNs), and to improve the individualized indications for postmastectomy radiotherapy (PMRT). Methods Clinical data of 489 patients with pT1-2N1M0 (1-3 positive ALNs) who did not receive PMRT in our hospital from 2009 to 2012 were analyzed retrospectively. The KaplanMeier method was used to calculate local recurrence rate (LRR), disease-free survival rate (DFS) and overall survival rate(OS). The Log-rank test and multivariate Cox analysis were used to determine the risk of LRR associated with different molecular types and to determine the clinicopathological factors associated with prognosis. Results In 489 breast cancer patients with pT1-2N1M0 and without PMRT, there were 229 patients with Luminal A subtype, 196 with Luminal B subtype(HER-2 negative) and 64 with triple-negative subtype, respectively. The median follow-up time was 75 months (range from5-115 months). The molecular typing analysis showed that the 5-year LRR of the triple-negative subtype was significantly higher than that of the non-triple-negative subtype (P＜0.05), and the 5-year DFS and the 5-year OS were significantly lower than the non-triple-negative subtypes (P＜0.05). There were no significant differences in 5-year LRR, DFS, and OS between Luminal A and Luminal B (HER-2 negative) in the non-triple-negative subtypes (P＞0.05 each). Multivariate Cox regression analysis showed that age ≤ 35 years, pT2 stage and triple-negative subtypes were independent poor prognostic factors for LRR. Conclusion Molecular subtyping is helpful for the individualized evaluation of LRR in pT1-2N1M0 breast cancer patients with 1-3 positive ALNs. We recommend PMRT to improve the prognosis for patients with age ≤ 35 years, pT2 stage and triple-negative subtypes.