摘要
目的通过分析pT1-2N0M0乳腺癌根治术后复发的高危因素,并应用倾向评分匹配法(PSM)分析探讨术后放疗获益的亚组患者。方法收集1998年8月-2008年8月的pT1-2N0M0乳腺癌根治术后患者993例,按是否行术后放疗分为放疗组(PMRT)和未放疗组(NPMRT),对NPMRT组通过COX多因素分析复发预后因素,根据影响局部复发独立因素个数,建立危险亚组(低危组、中危组和高危组)。对PMRT与NPMRT组间的临床病理特征进行倾向性评分匹配,匹配后的人群采用Kaplan-Meier法分析术后放疗作用。结果在低、中危组中放疗对局部区域复发率或总生存率的差异无统计学意义(P=0.715/0.215、P=0.880/0.377),高危组中的差异有统计学意义(P=0.035/0.034)。结论pT1-2N0M0患者总体复发率较低,但其中同时具有肿瘤直径≥4 cm、未绝经者、肿瘤位置(位于内侧或中央区)和雌激素受体(ER)阴性等的高危复发亚组患者5年局部区域复发率(LRR)高达21.1%,需给予术后放疗降低局部复发。
【Objective】 To determine the risk factors for local recurrence of pT1-2N0M0 breast cancer postmastectomy without radiotherapy and to identify which patients benefit from postmastectomy radiotherapy.【Methods】A total of 993 patients with pT1-2N0M0 (UICC seventh edition) breast cancer treated between August 1998 and August 2008 were retrospectively reviewed and divided into postmastectomy radiotherapy (PMRT) group and non-postmastectomy radiotherapy (NPMRT) group. Independent prognostic factors were analyzed by COX multivariate analysis in NPMRT group. Risk subgroups (low, middle and high risk group) were established according to the number of independent local-regional recurrence (LRR) risk factors. The disequilibrium characteristics of the PMRT and NPMRT groups were matched with propensity score matching (PSM), and the role of radiotherapy was analyzed by Kaplan-Meier after adjustment.【Results】 The significance of radiotherapy to LRR or overall survival (OS) was found no difference in low risk and middle risk groups (low risk: P=0.715, P=0.215 for LRR and OS;middle risk:/5 =0.880, P =0.377). However, radiotherapy was statistically different in the high risk group (P =0.035, P =0.034).【Conclusion】 The independent risk factors affecting LRR of pT1-2N0M0 breast cancer patients are: tumor >4cm, premenopausal state, tumor location or estrogen receptor (ER) negative, 5-year LRR rate of patients with all 4 risk factors was so high as 21.1%, and postoperative radiotherapy should be taken to decrease local recurrence.
作者
朱婷
单蓉
汪凤
李战战
黄隽
周卫兵
ZHU Ting;SHAN Rung;WANG Feng;LI Zhanzhan;HUANG Juan;ZHOU Weibing(Department of Oncology,Xiangy'a Hospital,Central South University,Changsha,Hunan 410008,China;Department of Breast Surgery,Xiangy'a Hospital,Central South University,Changsha,Hunan 410008,China)
出处
《中国医学工程》
2019年第4期1-7,共7页
China Medical Engineering
基金
国家自然科学基金(81572612)
国家临床重点专科建设项目(2014kll)
