早期乳腺癌新辅助化疗淋巴结转阴患者术后放疗的价值

目的 探讨乳腺癌术后放疗（PMRT）对新辅助化疗（NAC）后达到腋窝淋巴结阴性（ypN0）的临床 T1- 2N1M0期乳腺癌患者的治疗意义。方法 回顾性分析天津医科大学肿瘤医院2003—2013年收治的共187例在新辅 助化疗后达到ypN0的病理淋巴结阳性，临床分期T1-2N1M0同时接受手术治疗的乳腺癌患者的临床资料，所有入组 患者治疗前行淋巴结细针抽吸细胞活检（FNAB）进行病理分期。依据有无接受乳腺癌术后放疗将患者分为放疗组 （81例）和未放疗组（106例），并对2组患者的临床病理特征进行分析统计。采用Kaplan-Meier法测定无局部复发生 存（LRRFS）率、无远处转移生存（DMFS）率、无疾病生存（DFS）率和总生存（OS）率的生存曲线，Cox回归分析患者上 述几个生存指标的预后影响因素。结果 PMRT治疗组DFS和DMFS获得显著改善（P＜0.05），而LRRFS和OS组间 差异无统计学意义（P＞0.05）。NAC 后病理T 分期较早者、行PMRT 以及年龄≥40岁患者DMFS 和DFS 的预后较好 （P＜0.05）。软组织受累的患者LRRFS预后较差（P＜0.05）。结论 临床T1-2N1M0期乳腺癌NAC和改良根治术后 达到ypN0的乳腺癌患者总体生存情况较好，行术后放疗不能改善乳腺癌总生存质量和局部复发，但是能显著降低其 远处转移率以及提高无病生存率。

The role of postmastectomy radiotherapy after neoadjuvant chemotherapy in pathologically node-positive,stage T1-2N1M0 breast cancer patients with ypN0

Objective To investigate the effect of postmastectomy radiotherapy (PMRT) in patients with pathologically node-positive, stage T1-2N1M0 breast cancer after neoadjuvant chemotherapy (NAC) and mastectomy with ypN0. Methods A total of 187 pathologically node-positive, stage T1-2N1M0 breast cancer patients treated with NAC and modified radical mastectomy with and without PMRT who achieved ypN0 were retrospectively analyzed in our institution from 2003 to 2013. Patients all received fine needle aspiration biopsy (FNAB) of axillary nodes before NAC. Patients were divided into PMRT group (n=81) and NO PMRT group (n=106) according to whether they received postoperative radiotherapy for breast cancer. Statistical analyses were conducted using Chi-square test, Fisher exact test, Kaplan-Meier method, log-rank test and Cox proportional hazards regression model. Results DFS and DMFS were significantly improved in the PMRT group (P＜0.05), but there was no significant difference between the LRFFS and OS groups (P＞0.05). The prognosis of DMFS and DFS was better in patients with earlier pathological T stage, PMRT and age ≥ 40 years after NAC (P＜0.05). Patients with soft tissue involvement showed a poor prognosis (P＜0.05). Conclusion Patients with pathologically node-positive, stage T1-2N1M0 breast cancer, completed nodal response to NAC and received following modified radical mastectomy with ALND show comparatively good prognosis. PMRT could increase DFS and DMFS but have a marginal effect on LRR or OS in this study.