摘要
目的分析T1～T2期伴有腋窝淋巴结1～3个转移的乳腺癌患者接受术后淋巴引流区放疗后的淋巴结复发率和胸壁复发率,并分析腋窝淋巴结转移率与复发率的相互关系。方法320例的中位年龄44岁(26～72岁),根治术或改良根治术清扫腋窝淋巴结中位数8个(1～24个),淋巴结转移率中位值为25%(5%～100%)。术后行同侧内乳和锁骨上淋巴引流区放疗,中位剂量50Gy分25次。结果中位随访期93个月(7～205个月)。5年总生存率为89．7%,无瘤生存率为83．4%。总5年淋巴结复发率和胸壁复发率分别为7．9%、5．7%。淋巴结转移率＜30%和≥30%的5年淋巴结复发率分别为4．4%、14．2%(x^2=9．49,P=0．002)。淋巴结转移率＜30%和≥30%的5年胸壁复发率分别为3．5%、9．6%(x^2=5．61,P=0．018)。淋巴结转移率≥30%伴T2期的5年淋巴结复发率和胸壁复发率分别为15．8%和12．2%。淋巴结转移率≥30%伴年龄≤35岁的5年淋巴结复发率和胸壁复发率分别为40．0%和20．0%。多因素分析显示年龄和淋巴结转移率是总复发率的独立预后因素。胸壁复发率独立危险因素为淋巴结转移率。结论T1～T2期乳腺癌伴有腋窝淋巴结1～3个转移者中,淋巴结转移率≥30%伴T2期或年龄≤35岁者胸壁复发率较高,需考虑术后淋巴引流区域和胸壁放疗。
Objective To analyze the incidence and risk factors for regional nodal failure （RNF） and chest wall recurrence（CWR） in T1 or T2 breast cancer patients（ median age 44 year-range 26-72） with 1-3 positive axillary nodes treated with postmastectomy radiotherapy limited to the regional nodes. Methods From 1990 to 1999,320 patients were treated with postmastectomy（ radical or modified radical） radiotherapy confined to the supraclavicular and internal mammary nodes with a median dose of 50 Gy in 25 fractions over 5 weeks. The median number of nodes examined was 8 （range 1-24 ）. The median lymph nods rate （LNR） was 25% （ range 5% -100% ）. Results The 5-year overall survival rate and disease free survival rate was 89.7% and 83.4%, respectively. The 5-year RNF and CWR was 7.9% and 5.7%, respectively. The 5-year RNF in patients with LNR 〈 30% and t〉30% was 4.4% and 14.0% （P = 0. 002）. The 5-year CWR in the subgroups with LNR 〈 30% and 〉t30% was 3.5% and 9.6% （P = 0. 018）. In age≤35 year old patients with LNR≥30% , the 5-year RNF and CWR was 40.0% and 20.0%. In T2 patients with LNR ≥30%, the 5-year RNF and CWR was 15.8% and 12.2%. Age and LNR were independent prognostic factors for RNF ＋ CWR, LNR was the only independent prognostic factor for CWR by multivariate analysis. Conclusions In T1 or T2 breast cancer patients with 1-3 positive axillary nodes treated with radical or modified radical mastectomy, a relatively high incidence of chest wall recurrence is observed in the subgroup of patients with lymph nods rate of 30% or greater accompanied by a T2 primary tumor or age≤35 years old. Lymph nodes rate is the only significant prognostic factor of chest wall recurrence. For these patients, post- operative lymphatic drainage area and chest wall irradiation should be considered.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2006年第5期396-400,共5页
Chinese Journal of Radiation Oncology
关键词
乳腺肿瘤/放射疗法
术后放疗
预后
Breast neoplasms/radiotherapy
Postoperative radiotherapy
Prognosis
