放疗显著改善HER-2过表达局部晚期乳腺癌改良根治术后LRC率

目的 分析激素受体阴性、HER-2基因过表达局部晚期乳腺癌的局部复发风险和放疗作用。方法 回顾分析1999—2011年间294例激素受体阴性、HER-2基因过表达局部晚期乳腺癌患者资料, 其中239例接受改良根治术后辅助放疗, 55例因各种原因未接受放疗, 比较两组生存率和LRR率。Kaplan-Meier法计算生存率和复发率, Logrank法检验和单因素预后分析, Cox回归模型多因素预后分析。结果 5年样本数为162例。全组56例局部复发, 5年无LRR率为79.7%, 5年OS率为70.0%。放疗显著提高了5年LRRFS率(85.1%和56.0%, P=0.000), 但两组OS率相近(71.3%和64.2%, P=0.441)。多因素分析显示辅助放疗是无LRR影响因素(RR=0.303, 95%CI 0.166~0.554, P=0.000)。结论 激素受体阴性、HER-2基因过表达局部晚期乳腺癌术后放疗显著降低了局部复发率。

Radiotherapy following modified radical mastectomy significantly improves locoregional control in patients with Rec-/HER-2+ locally advanced breast cancer

Objective To evaluate the risk of locoregional recurrence (LRR) and role of radiotherapy for patients with estrogen receptor-negative and human epidermal growth factor receptor 2-overexpressed (Rec-/HER-2+) locally advanced breast cancer (LABC). Methods A retrospective analysis was performed on the clinical data of 294 patients with Rec-/HER-2+ LABC from 1999 to 2011. All patients were treated with modified radical mastectomy (MRM). Of them, 239 patients received postmastectomy radiotherapy and 55 patients did not. Locoregional recurrence-free survival (LRRFS) and overall survival (OS), as well as LRR, were compared between the two groups. The Kaplan-Meier method was used to estimate survival and recurrence rates, and the log-rank test was used for survival difference analysis and univariate prognostic analysis. Multivariate prognostic analysis was performed using the Cox regression model. Results The 5-year sample size was 162. Fifty-six patients developed LRR. The 5-year LRRFS and OS rates were 79.7% and 70.0%, respectively. Postmastectomy radiotherapy significantly increased the 5-year LRRFS rate (85.1% vs. 56.0%, P=0.000), but did not significantly increase the 5-year OS rate (71.3% vs. 64.2%, P=0.441). Multivariate analysis indicated that postmastectomy radiotherapy was the only independent prognostic factor associated with increased LRRFS (RR=0.303, 95%CI:0.166-0.554, P=0.000). Conclusions Patients with Rec-/HER-2+ LABC treated with MRM alone appear to be at a significantly increased risk of LRR compared with those treated with MRM followed by radiotherapy.