初诊同侧锁骨上淋巴结转移乳腺癌综合治疗疗效

目的 探讨应用新辅助化疗+手术+放疗治疗初诊为锁骨上淋巴结转移乳腺癌患者疗效。方法 回顾分析1999-2013年肿瘤医院收治的65例女性乳腺癌患者的病历资料。全部患者均经初诊病理结果确诊为乳腺癌,且经病理或影像学检查证实为锁骨上淋巴结转移、无远处转移及其他第二原发癌,完整接受术前化疗+手术+术后放疗方案。采用Kaplan-Meier法计算总生存(OS)、无进展生存(PFS)及锁骨上淋巴结复发(SCFR)率,Logrank法检验差异。结果 中位随访时间66个月(6~137个月)。65例患者中5例患者治疗后锁骨上淋巴结复发。全组患者5年SCFR、OS、PFS率分别为9%、72%、50%。术前化疗后锁骨上淋巴结完全缓解是影响OS因素,是否完全缓解患者5年OS率分别为81%和54%(P=0.035)。初诊锁骨上淋巴结大小 (短径≤1 cm、>1 cm)为5年SCFR(分别为0%、21%,P=0.037)和5年OS(分别为86%、56%,P=0.001)的高危因素。结论 对于初诊为锁骨上淋巴结转移的乳腺癌患者,完整接受术前化疗+手术+术后放疗方案治疗后的OS率较高,锁骨上区放疗可获得良好的肿瘤局部控制。

Clinical efficacy and prognosis of breast cancer patients with ipsilateral supraclavicular lymph node metastases treated with multi-modality therapy at diagnosis

Objective To investigate the clinical efficacy and prognostic factors of breast cancer patients with ipsilateral supraclavicular lymph node metastasis (ISLNM) receiving neoadjuvant chemotherapy, surgery combined with radiotherapy at diagnosis. Methods Therapeutic outcomes of 65 breast cancer patients with ISLNM treated in our hospital between 1999 and 2013 were retrospectively analyzed. All patients were pathologically diagnosed with breast cancer. They were complicated with ISLNM, without distant metastasis confirmed by pathological or imaging examinations. All patients received multi-modality therapy consisting of neoadjuvant chemotherapy, surgery and postoperative radiotherapy. Kaplan-Meier method was adopted to calculate the overall survival (OS),progression-free survival (PFS) and supraclavicular lymph node recurrence (SCFR).The differences between two groups were statistically analyzed by the log-rank test. Results The median follow-up time was 66 months (range:6-137 months).Five patients had SCFR after corresponding treatment. The overall 5-year SCFR,OS and PFS rates were 9.2%,71.5% and 49.5%,respectively. Following preoperative chemotherapy, the complete response (CR) of supraclavicular lymph node was a prognostic factor affecting OS. The 5-year OS rates in patients with and without CR were 81.4% and 53.9%(P=0.035).The size of supraclavicular lymph node (≤1 cm vs. >1 cm at diagnosis was a risk factor of the SCFR (0% vs. 21.0%,P=0.037) and OS rates (≤1 cm vs. >1 cm:86.1% vs. 55.6%,P=0.001). Conclusions Breast cancer patients with ISLM at diagnosis can obtain high OS rate and excellent tumor control after undergoing multi-modality therapy consisting of preoperative chemotherapy,surgery and postoperative radiotherapy.