中高危老年乳腺癌患者改良根治术后放疗的意义

目的 探讨中高危老年(≥65岁)乳腺癌患者改良根治术后放疗(PMRT)的意义.方法 收集874例改良根治术后中高危乳腺癌患者的临床资料,回顾性分析不同年龄组患者接受PMRT的情况和PMRT的作用,其中T3～T4和(或)N2～N3为高危组,T1～T2N1为中危组.结果 ≥65岁的患者108例,占12.4%.与＜65岁的患者相比,≥65岁的患者中,病理学分级为Ⅲ级、N3、高危和化疗患者所占的比例低,而合并其他疾病和有恶性肿瘤史者所占的比例高.≥65岁的患者中,中危组和高危组患者接受放疗的比例分别为15.3%和52.2%;＜65岁的患者中,中危组和高危组患者接受放疗的比例分别为18.1%和82.7%.≥65岁的患者中,中危组放疗和未放疗者的5年局部区域复发率分别为0和14.2%(P=0.242),5年总生存率分别为100%和75.2%(P=0.159);高危组放疗和未放疗者的5年局部区域复发率分别为0和14.1%(P=0.061),5年总生存率分别为84.6%和77.4%(P=0.597).＜65岁的患者中.中危组放疗和未放疗者的5年局部区域复发率分别为0和9.9%(P=0.035),5年总生存率分别为87.0%和82.1%(P=0.739);高危组放疗和未放疗者的5年局部区域复发率分别为7.2%和26.1%(P=0.000),5年总生存率分别为79.2%和57.7%(P=0.000).结论 不同年龄的中危组患者实施PMRT的比例相仿,但对于高危组患者,接受PMRT的比例随着患者年龄的增长而降低.高危老年乳腺癌患者实施PMRT可能可以降低局部区域复发率,应支持放疗.

Postmastectomy radiotherapy in moderate-and high-risk elderly breast cancer patients

Objective To analyze the role of postmastectomy radiotherapy(PMRT)in moderateand high-risk elderly breast cancer patients.Methods The clinicopathological data of 874 breast cancer patients treated with mastectomy and axillary dissection were retrospectively analyzed.The T1-2N1 patients were defined as moderate.risk(IR)group,and T3-4 and/or N2-3 cases as high-risk(HR)group.The locoregional recurrence(LRR)and overall survival(OS)rates were calculated and compared according to different age groups and radiotherapy status.Kaplan-Meier method and log-rank test was ased for calculation and comparison of the survival Curves of different patient groups.Results The median follow up time was 47 months.108(12.4%)patients were≥65 years.For patients who were＜65 and≥65 years,18.1%and 15.3%received PMRT in the IR group,and 82.7%and 52.2%received PMRT in the HR group,respectively.For patients≥65 years,the 5-year LRR rates were 0%and 14.2%(P=0.242)and 5-year OS rates were 100%and 75.2%(P=0.159)for the PMRT-IR and non-PMRT-IR groups,respectively.The 5-year LRR rates were 0%and 14.1%(P=0.061),5-year OS rates were 84.6%and 77.4%(P=0.597)for the PMRT-HR and non-PMRT-HR groups,respectively.For patients＜65 years,the 5-year LRR rates were 0%and9.9%(P=0.035)and 5-year OS rates were 87.0%and 82.1%(P:0.739)for the PMRT-IR and non-PMRT-groups.respectively.The 5-year LRR rates were 7.2%and 26.1%(P=0.000),5-year OS rates were 79.2%and 57.7%(P:0.000)for the PMRT-HR and non-PMRT-HR groups,respectively.Conclusion With the increasing of age,there is a trend of decreasing use of postmastectomy radiotherapy in high-risk breast caflcer patients.Postmastectomy radiotherapy can improve the locoregional control for high-risk patients and maybe considered even for those who are ≥65 years.