摘要
目的:探讨乳腺癌术后放疗锁骨上淋巴引流区靶区内侧界设为颈内动静脉间隙而不包括颈总动脉是否会影响乳腺癌区域控制率和生存结果。方法:回顾性分析2017-2018年间在我中心接受乳腺癌术后辅助放疗的163例患者病例资料,将患者分为观察组(靶区内侧界为颈内动静脉间隙,避开颈总动脉)和对照组(靶区内侧界包含颈总动脉),采用生存分析方法比较两组在锁骨上窝和锁骨下窝无复发生存率(supraclavicular and infraclavicular fossa recurrence-free survival,SFRFS)、无病生存率(disease-free survival,DFS)和总生存率(overall survival,OS)方面的差异。并通过多因素分析识别与预后相关的独立危险因素。结果:研究最终纳入150名IIA-IIIC期符合条件的患者,中位随访76个月(26~92个月)。总人群中,3例患者发生同侧胸壁/乳腺复发,5例发生同侧锁骨上/锁骨下淋巴结复发。Cox回归分析结果示,观察组与对照组SFRFS、DFS、OS均无统计学差异:5年SFRFS:97.5%vs 95.3%,P=0.469(HR=0.522,95%CI:0.087~3.126);5年DFS:83.1%vs 77.6%,P=0.589(HR=0.886,95%CI:0.460~1.706);5年OS:95.0%vs 94.0%,P=0.359(HR=0.588,95%CI:0.186~1.855)。单因素和多因素分析显示,锁骨上/下淋巴结复发(supra-or infraclavicular fossa relapse,SCFR)显著影响远处转移的概率(P<0.001)和总生存期(P=0.013),而远处转移显著影响总生存期(P<0.001)。分期(P=0.013)是SCFR的主要影响因素。年龄、手术方式(保乳或改良根治术)、激素受体(HR)状态、HER-2状态、Ki-67、化疗方案对于II期及III期乳腺癌患者的远处转移和OS均无显著影响。结论:IIA-IIIC期乳腺癌术后辅助放疗靶区包含颈总动脉似乎无法改善锁骨上下局部区域控制率和生存率。这些数据支持锁骨上淋巴结放疗靶区可避开颈总动脉。
Objective:To evaluate whether defining the medial boundary of the supraclavicular lymphatic drainage target area as the space between the internal jugular vein and common carotid artery,excluding the common carotid artery will affect the regional control rates and survival outcomes in breast cancer patients following postoperative radiotherapy.Methods:We retrospectively analyzed the clinical data of 163 breast cancer patients who received adjuvant radiotherapy at our center between 2017 and 2018.Patients were classified into two groups:The observation group(target area medial boundary defined as the space between the internal jugular vein and common carotid artery,sparing the common carotid artery)and the control group(target area medial boundary including the common carotid artery).Survival analysis was conducted to estimate and compare the supraclavicular and infraclavicular fossa recurrence-free survival(SFRFS),disease-free survival(DFS),and overall survival(OS)between the two groups.Furthermore,independent prognostic risk factors were identified through multivariate analysis.Results:A total of 150 patients with stage IIA-IIIC breast cancer met the eligibility criteria,with a median follow-up period of 76 months(range:26~92 months).During the follow-up,3 patients had ipsilateral chest wall/breast recurrences,and 5 patients experienced supraclavicular/infraclavicular lymph node recurrences.Cox regression analysis revealed no statistically significant differences between the observation and control groups in terms of SFRFS,DFS,or OS.The 5-year SFRFS rates were 97.5%and 95.3%,respectively(P=0.469,HR=0.522,95%CI:0.087~3.126).The 5-year DFS rates were 83.1%versus 77.6%(P=0.589,HR=0.886,95%CI:0.460~1.706),and the 5-year OS rates were 95.0%versus 94.0%(P=0.359,HR=0.588,95%CI:0.186~1.855).Both univariate and multivariate analyses demonstrated that the supra-or infraclavicular fossa relapse(SCFR)significantly increased the risk of distant metastasis(P<0.001)and decreased overall survival(P=0.013).Additionally,distant metastasis was itself a significant predictor of overall survival(P<0.001).Disease stage(P=0.013)was identified as the primary factor influencing SCFR.Other variables,including age,type of surgery(breast-conserving or modified radical mastectomy),hormone receptor(HR)status,HER-2 status,Ki-67,and chemotherapy regimens,did not have a significant impact on distant metastasis or OS in patients with stage II and III breast cancer.Conclusion:Including the common carotid artery in the radiation target volume does not seem to improve regional control or survival outcomes in patients with stage IIA-IIIC breast cancer undergoing adjuvant radiotherapy.These findings support the exclusion of the common carotid artery from the supraclavicular lymph node radiation target area.
作者
张艳贤
陆颖
杨慧
许卓华
ZHANG Yanxian;LU Ying;YANG Hui;XU Zhuohua(Department of Oncology,the Fourth Affiliated Hospital of Guangxi Medical University,Guangxi Liuzhou 545005,China)
出处
《现代肿瘤医学》
2026年第2期240-246,共7页
Journal of Modern Oncology
基金
广西自治区卫健委科研课题(编号:Z-B20231427)。
关键词
乳腺癌
锁骨上淋巴结
放射治疗
生存分析
breast cancer
supraclavicular lymph nodes
radiotherapy
survival analysis
