术后放疗对T1-2N1M0期三阴乳腺癌患者预后的影响

目的 分析T1-2N1M0期三阴性乳腺癌（TNBC）患者行改良根治术后放疗与否对生存的影响。方法 回顾性分析2004年1月至2010年9月接受改良根治术后129例T1-2N1M0期TNBC患者的临床资料，其中61例行术后常规放疗（放疗组），68例未行放疗（未放疗组）。分析两组5年总生存率、5年无局部复发生存率和5年无病生存率以及影响局部复发的因素。结果 中位随访时间为67个月，全组患者中27例（20.9％）出现局部区域复发。放疗组较未放疗组提高了5年无局部复发生存率（88.5％ vs. 70.6％，P=0.017）和5年无病生存率（78.7％ vs.63.2％， P=0.068）。放疗组和未放疗组的5年生存率分别为88.5％和82.4％（P=0.341）。单因素分析显示年龄、T分期、淋巴结阳性数、是否放疗是影响无局部复发生存的预后因素（P＜0.05）。多因素分析显示未放疗（HR=3.432，P=0.010）和淋巴结3枚阳性（HR=2.915，P=0.020）是影响局部区域复发的独立预后因素。结论 术后放疗可明显改善T1-2N1M0期TNBC患者的无局部复发生存。淋巴结3枚阳性者局部控制更差，增加区域淋巴结照射是可行的。

The value of radiotherapy in patients with T1-2 N1 M0 triple-negative breast cancer after modified radical mastecomy

Objective To analyze the prognosis of patients with T1-2 N1 M0 triple-negative breast cancer(TNBC) after modified radical mastectomy with or without postoperative radiotherapy. Methods One hundred and twenty-nine patients diagnosed with T1-2 N1 M0 TNBC after modified radical mastectomy from Jan. 2004 to Sep. 2010 were retrospectively reviewed. Of whom 61 cases received postoperative radiotherapy and 68 cases did not. The 5-year overall survival(OS), locoregional recurrence-free survival(LRFS)and dis-ease-free surviva(DFS) rates of the two groups were observed. The risk factors for LRFS were analyzed in combination with clinical and patholgical features. Results With a median follow-up of 67 months, 27 patients developed locoregional recurrence. The patients trea-ted with radiotherapy had significantly higher LRFS rates(88. 5% vs. 70. 6%, P= 0. 017) as well as slightly higher DFS rates(78. 7%vs. 63. 2%,P= 0. 068).The 5-year OS rates were 88. 5% and 82. 4%(P= 0. 068), respectively. The univariate analysis indicated that age, T stage, the number of positive lymph nodes and postoperative radiotherapy were significant influencing factors for LRFS( P<0. 05). The multivariate analysis showed that no radiotherapy(HR = 3. 432,P = 0. 010) and 3 positive lymph nodes(HR = 2. 915,P =0. 020)were independent prognostic factors for LRFS. Conclusion T1-2 N1 M0 TNBC after modified radical mastectomy patients may benefit from radiotherapy, which significantly improves locoregional recurrence-free survival. The local control rates of patients with 3 positive axillary nodes was worse, so increasing regional lymph node irradiation should be feasible.