| 周咏春,阳耀国,孙楠,谢凌霄,孙祥露,李傲雪,吴琼,张蕾,江浩.HER2阳性T1~2N1M0乳腺癌改良根治术后放疗疗效的影响因素分析[J].中华放射医学与防护杂志,2023,43(9):676-681 |
| HER2阳性T1~2N1M0乳腺癌改良根治术后放疗疗效的影响因素分析 |
| Efficacy of postmastectomy radiotherapy for HER2-positive T1-2N1M0 breast cancer |
| 投稿时间：2023-05-08 |
| DOI：10.3760/cma.j.cn112271-20230508-00136 |
| 中文关键词: 乳腺癌 HER2阳性 抗HER2靶向治疗 术后放疗 |
| 英文关键词:Breast cancer Human epidermal growth factor receptor 2 (HER2) positive Anti HER2 targeted therapy Postmastectomy radiotherapy (PMRT) |
| 基金项目:国家自然科学基金（31200633）；安徽省自然科学基金（2008085MH245）；蚌埠医学院"512人才培育计划"项目（by51201211） |
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| 中文摘要: |
| 目的 探讨抗人表皮生长因子受体2（HER2）阳性的T1~2N1M0乳腺癌改良根治术后放疗（PMRT）的作用。方法 回顾性选取2013年1月至2019年12月在蚌埠医学院第一附属医院行乳腺癌改良根治术的T1~2N1M0、HER2（+）的105例女性患者临床资料，观察其临床结局，分析预后影响因素和PMRT的作用。结果 患者的中位随访时间为50个月（范围14~107个月），5年总生存率（OS）、无局部区域复发生存率（LRFS）和无病生存率（DFS）分别为81.6%、91.9%和76.2%。多因素分析显示，年龄、病理分级、肿瘤大小是OS和DFS的独立预后因素，阳性淋巴结比率（LNR）和激素受体（HR）状态是影响LRFS的独立危险因素，而PMRT则是影响DFS的独立预后因素（HR：2.85，95%CI：1.10~8.80，P < 0.05）。亚组分析提示，PMRT能够显著提高各高风险亚组的OS（χ2=4.01~9.18，P < 0.05）。进一步分层分析显示，在各高风险亚组中，与未放疗相比，PMRT仅提高了未行抗HER2靶向治疗人群的OS（χ2=4.50~6.70，P < 0.05），而对靶向治疗人群未见改善的趋势（P > 0.05）。结论 PMRT是影响HER2（+）T1~2N1M0乳腺癌改良根治术后患者DFS的独立预后因素。PMRT能改善年龄<45岁、病理Ⅲ级、肿瘤直径≥ 3 cm、LNR>10%、HR（-）、未行抗HER2靶向治疗高危人群的OS，而在抗HER2靶向治疗背景下，其作用可能存在一定程度的弱化。 |
| 英文摘要: |
| Objective To investigate the efficacy of postmastectomy radiotherapy (PMRT) for human epidermal growth factor receptor 2 (HER2)-positive T1-2N1M0 breast cancer in the context of HER2-targeted therapy.Methods This study collected the clinical data of 105 female patients with HER2-positive T1-2N1M0 breast cancer who underwent modified radical mastectomy in the First Affiliated Hospital of Bengbu Medical College from January 2013 to December 2019. Then, the clinical outcomes of these patients were observed, and the prognostic factors and the efficacy of PMRT were analyzed.Results The median follow-up time was 50 months (ranging from 14 to 107 months), and the 5-year overall survival (OS), local-regional recurrence-free survival(LRFS), and disease-free survival (DFS) were 81.6%, 91.9%, and 76.2%, respectively. The multivariate analysis indicated that independent prognostic factors for OS and DFS include the age, pathologic grade, and tumor size; the independent risk factors for LRFS include positive lymph node ratio (LNR) and hormone receptor (HR) status; and the independent prognostic factor for DFS was PMRT (HR:2.85, 95%CI:1.10-8.80, P < 0.05). The subgroup analysis suggested that PMRT significantly improved the OS of various high-risk subgroups (χ2=4.01-9.18, P < 0.05). However, the further stratified analysis indicated that PMRT only increased the OS of the patients who did not receive HER2-targeted therapy in various high-risk subgroups (χ2=4.50-6.70, P < 0.05), while there was no statistical difference before and after PMRT for the individuals who received targeted treatment (P > 0.05).Conclusions PMRT is an independent prognostic factor for the DFS of patients with HER2-positive T1-2N1M0 breast cancer who underwent modified radical mastectomy. PMRT can improve the OS of high-risk patients with ages < 45 years old, pathologic grade Ⅲ, tumor diameter ≥ 3 cm, LNR > 10%, and HR (-) who received no HER2-targeted therapy. However, the efficacy may be compromised to some extent in the context of the application of HER2-targeted therapy. |
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