摘要
目的分析Ⅰ—Ⅱ期乳腺癌保乳术后放疗的临床疗效和预后因素。方法回顾分析1999—2013年1376例Ⅰ、Ⅱ期(T1-2N0-1/T3N0)单侧乳腺癌保乳术后放疗的疗效。930例(67.6%)同时接受化疗,先放疗后化疗517例,先化疗后放疗413例。1055例(76.7%)患者接受内分泌治疗,86例(39.6%)HER-2阳性患者接受靶向治疗。用Kaplan-Meier计算生存率并Logrank法单因素分析,Cox法多因素分析。结果中位随访55个月,10年样本量90例。全组5、10年OS率分别为98.6%和91.5%,DFS率分别为94.6%和82.8%。多因素分析显示年龄(P=0.016)、T分期(P=0.006)、N分期(P=0.004)、脉管癌栓(P=0.038)和放疗距手术时间(P=0.048)是DFS独立预后因素。保乳术后单纯放疗组多因素分析显示,N分期(P=0.044)和ER水平(P=0.026)是DFS独立预后因素。结论Ⅰ—Ⅱ期乳腺癌保乳术后以放疗为主的综合治疗模式临床疗效满意。影响DFS率的因素包括年龄、T分期、N分期、脉管癌栓和放疗距手术时间。保乳术后单纯放疗组的DFS率和N分期与ER水平有关。
Objective To evaluate the clinical efficacy and analyze the prognostic factors of radiotherapy after breast-conserving surgery for stage Ⅰ—Ⅱ breast cancer patients. Methods Clinical efficacy of adjuvant radiotherapy in 1376 patients with stage Ⅰ and Ⅱ(T1-2N0-1M0/T3N0M0) breast cancer after undergoing unilateral breast-conserving surgery between 1999 and 2013 was retrospectively reviewed. Among them, 930 patients (67.6%) received radiotherapy combined with chemotherapy including 517 receiving radiotherapy followed by chemotherapy and 413 receiving chemotherapy followed by radiotherapy. In total, 1055 patients (76.7%) were treated with endocrine therapy. Eighty-six patients (39.6%) positive for HER-2 received targeted therapy. The overall survival (OS) and disease-free survival (DFS) rates were calculated using the Kaplan-Meier method. Univariate analysis was performed by Log-rank test and multivariate analysis was conducted by Cox regression method. Results The median follow-up time was 55 months. The quantity of patients receiving follow-up for ≥ 10 years was 90. The 5-and 10-year OS rates for all patients were 98.6% and 91.5%, and 94.6% and 82.8% for 5-and 10-year DFS rates. Mutivariate analysis revealed that age (P=0.016),T staging (P=0.006),N staging (P=0.004), lymphovascular invasion (P=0.038) and time interval between radiotherapy and surgery (P=0.048) were independent prognostic factors for DFS rate. Multivariate analysis demonstrated that N staging (P=0.044) and ER (P=0.026) were independent prognostic factors for DFS in the radiotherapy alone group. Conclusions The radiotherapy-based comprehensive treatment yields favorable clinical outcomes for stage Ⅰ—Ⅱ breast cancer patients after undergoing breast conserving surgery. The prognostic factors for DFS include age, T staging, N staging, lymphovascular invasion and the time interval between radiotherapy and breast-conserving surgery. In the radiotherapy alone group, DFS rate is associated with N staging and ER level.
作者
钟秋子
荣庆林
唐玉
杨勇
隆榴花
金晶
刘跃平
宋永文
房辉
陈波
亓妹楠
李宁
唐源
张江鹄
卢宁宁
李晔雄
Zhong Qiuzi;Rong Qinglin;Tang Yu;Yang Yong;Long Liuhua;Jin Jing;Liu Yueping;SongYongwen;Fang Hui;Chen Bo;Qi Shunan;Li Ning;Tang Yuan;Zhang Jianghu;Lu Ningning;Li Yexiong(Department of Radiation Oncology,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Scienceand Peking Union Medical College,Beijing 100021,China;Department of Radiation Oncology,General Hospital of Tianjin Medical University,Tianjin 300052;Department of Radiation Oncology,Xuanwu Hospital of Capital Medical University,Beijing100053,China)
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2018年第2期165-169,共5页
Chinese Journal of Radiation Oncology
基金
国家重大研发计划“以生物组学特征与多模态功能影像为基础的多线束精准放疗方案研究”(2016YFC0904600)
中国医学科学院医学与健康科技创新工程(2016-12M-1-001)
