张锋,张卓,邹丽娟,宣伟.早期三阴乳腺癌改良根治术后放疗及预后相关因素分析[J].中华放射医学与防护杂志,2018,38(7):510-516
早期三阴乳腺癌改良根治术后放疗及预后相关因素分析
Analysis of the prognostic factors and the value of radiotherapy in the early stage triple-negative breast cancer
投稿时间:2017-10-23  
DOI:10.3760/cma.j.issn.0254-5098.2018.07.006
中文关键词:  三阴乳腺癌  术后放疗  预后
英文关键词:Triple-negative breast cancer  Postoperative radiotherapy  Prognosis
基金项目:国家自然科学基金(11705095)
作者单位E-mail
张锋 116027 大连医科大学附属二院放疗科  
张卓 116027 大连医科大学附属二院放疗科 799832582@qq.com 
邹丽娟 116027 大连医科大学附属二院放疗科  
宣伟 223600 沭阳, 江苏省沭阳县人民医院放疗科  
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中文摘要:
      目的 分析研究早期(T1~2N1M0)三阴乳腺癌患者改良根治术后放疗及预后危险因素,为该分期三阴乳腺癌患者临床治疗方案的选择提供依据。方法 回顾性分析2006年1月至2011年10月大连医科大学附属二院收治的术后病理分期为T1~2N1M0三阴乳腺癌患者共87例。根据术后是否放疗将患者分为放疗组(53例),未疗组(34例)。Kaplan-Meier单因素分析术后放疗、年龄、月经、组织学分级、脉管癌栓、T分期、淋巴结阳性数及转移率、手术方式、Ki-67指数等对患者5年局部区域复发率(LRR)、远处转移(DM)率、无复发生存(RFS)率、总生存(OS)率预后的影响。结果 术后放疗组与未疗组5年LRR(9.4%和15.2%)和RFS(81.3%和66.7%)比较,差异有统计学意义(χ2=8.073、12.789,P<0.05),而DM及OS两组比较差异无统计学意义(P>0.05)。单因素分析结果显示,放疗、淋巴结转移率、年龄、Ki-67指数是影响5年LRR的危险因素(P<0.05);脉管癌栓、淋巴结转移率是影响 5 年 DM 的危险因素(P<0.05);放疗、脉管癌栓、淋巴结转移率和Ki-67指数是影响5年 RFS 的危险因素(P<0.05)。多因素分析结果显示,放疗和淋巴结转移率是影响5年LRR的独立危险因素(HR=0.279、5.277 P<0.05);脉管癌栓是影响5年DM的独立危险因素(HR=2.313, P<0.05);放疗、脉管癌栓和淋巴结转移率是影响5年RFS 独立危险因素(HR=0.378、2.35、5.084, P<0.05)。结论 术后放疗可以改善T1~2N1M0期三阴乳腺癌患者的局部控制率,但对5年的DM和OS影响不大。术后放疗、淋巴结转移率、脉管癌栓、Ki-67指数、年龄与早期三阴乳腺癌预后相关。
英文摘要:
      Objective To analyze the prognostic factors and the value of radiotherapy (RT) for the early stage (T1-2N1M0) triple-negative breast cancer (TNBC) patients after modified radical mastectomy, and provide a basis for the selection of the clinical treatment strategy. Methods The retrospective analysis was performed in 87 TNBC patients at T1-2N1M0 stage. All patients were admitted to the Second Affiliated Hospital of Dalian Medical University from Jan 2006 to Oct 2011. Fifty-three cases received postoperative RT (RT group), and the other 34 cases without RT (non-RT group). Factors enrolled in Kaplan-Meier analysis were postoperative RT, age, menstruation, histological grade, vascular tumor thrombus, T staging, the number of positive lymph node and metastasis rate, surgery procedure, Ki-67 index. The endpoints were local regional recurrence rate (LRR), distant metastasis rate (DM), recurrence free survival (RFS), and overall survival (OS) rate for 5 years. Results The significant difference was found in the 5-year LRR (9.4% vs. 15.2%) and RFS (81.3% vs. 66.7%) between RT group and non-RT group (χ2=8.073, 12.789, P<0.05). No significant difference in the DM and OS was observed between the two groups (P>0.05). The univariate analysis showed that RT, lymph node metastasis, age, and Ki-67 index were the risk factors for 5-year LRR (P<0.05), while vascular thrombus and lymph node metastasis rate were risk factors for 5-year DM (P<0.05), RT, vascular tumor thrombus, lymph node metastasis rate, and Ki-67 index 5-year RFS (P<0.05). The multivariate analysis showed that RT and lymph node metastasis were the independent risk factors for 5-year LRR (HR=0.279, 5.277, P<0.05), vascular thrombus was an independent risk factor 5-year DM (HR=2.313, P<0.05), while RT, vascular tumor thrombus and lymph node metastasis rate were the independent risk factors for 5 years RFS (HR=0.378, 2.350, 5.084, P<0.05). Conclusions Postoperative RT might improve the local control rate of TNBC patients at T1-2N1M0 stage, while the effect on DM and OS in 5 years was little. Postoperative RT, lymph node metastasis rate, vascular tumor thrombus, Ki-67 index and age are related to patient's prognosis of early stage TNBC.
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