保乳术后放疗对乳腺癌局部淋巴结转移患者预后的影响

  目的  探讨术后放疗(post-mastectomy radiation therapy, PMRT)对局部淋巴结阳性行保乳手术的乳腺癌患者预后的影响, 针对不同的pN分期以及淋巴结转移率(lymph node ratio, LNR)提出更具针对性的术后放疗方案。  方法  回顾性分析天津医科大学肿瘤医院1998年2月至2007年3月152例行保乳手术并有局部淋巴结转移的原发浸润性乳腺癌患者的临床病理资料, 比较LNR和pN分期对患者预后的指导意义, 并在LNR基础上, 根据PMRT与否比较无病生存期(disease-free survival, DFS)和总生存期(overall survival, OS)。  结果  152例患者被分为pN1(114例)、pN2(23例)、pN3(15例), 其中LNR < 0.21为114例, 位于0.21~0.65为26例, >0.65为12例。单因素分析显示淋巴结切检总数、pN、LNR、雌激素受体(estrogen receptor, ER)状态、孕激素受体(progesterone receptor, PR)状态、放疗与否均与DFS、OS具有相关性(P < 0.05), 诊断年龄和化疗方案仅与OS具有相关性(P < 0.05)。多因素分析显示, LNR、PMRT依然是DFS、OS的独立预测指标(P < 0.05), 而pN差异无统计学意义(P>0.05);分组分析时仅在LNR < 0.21术后放疗对预后的影响差异有统计学意义。  结论  LNR作为一个独立预测指标, 可用于评价行保留乳房手术治疗发生淋巴结转移的乳腺癌患者的预后。针对不同的LNR分级, 需要进一步细化PMRT的适应症。 

Prognostic value of post-mastectomy radiation therapy in node-positive breast cancer patients treated with breast conservation therapy

  Objective  To evaluate the prognostic value of post-mastectomy radiation therapy (PMRT) in patients with axillary lymph node-positive breast cancer treated with breast conservation surgery and to establish the candidates for PMRT based on different pN stages and lymph node ratios (LNR).  Methods  A retrospective analysis of the clinical data of the patients was conducted.The patients had positive lymph nodes (n=152) between 1998 and 2007 and underwent breast conservation surgery.A comparison of the disease-free survival (DFS) and overall survival (OS) rates was conducted based on LNR and pN staging and with PMRT as a prognostic factor.  Results  A total of 152 cases were studied, of which 114 were pN1, 23 were pN2, and 15 were pN3.Among these cases, 114 had an LNR ranging from 0.01 to 0.20, 26 had an LNR from 0.21 to 0.65, and 12 had an LNR>0.65.Univariate analysis showed that the number of dissected lymph nodes, LNR, pN stage, estrogen and progesterone receptor status, and radiotherapy were the prognostic factors for DFS and OS rates (P < 0.05).Age and chemotherapy were prognostic factors only for OS rate (P < 0.05).Multivariate analysis indicated that PMRT and LNR were independent prognostic factors of DFS and OS (P < 0.05).The pN staging had no significant effect on DFS or OS (P>0.05).In the subgroup analysis, PMRT had significant effect on DFS and OS (P < 0.05) in patients with pN1 and LNR < 0.21.  Conclusion  LNR is an independent prognostic factor in axillary lymph node-positive breast cancer patients treated with breast conservation surgery, and a candidate for PMRT should be established based on different LNR risks.