[早期乳腺癌的乳房切除术后放疗]

[Postmastectomy radiotherapy for early breast cancer].

作者信息

Wang Shulian, Li Yexiong, Yu Zihao

机构信息

Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2002 Jan;24(1):68-70.

PMID:11977644

Abstract

OBJECTIVE

To investigate the value of postmastectomy radiotherapy for early breast cancer.

METHODS

From 1983 to 1991, 605 patients with T1-2N0-1M0 breast cancer were treated by radical mastectomy in our hospital. 149 patients underwent surgery alone(S group), and the remaining 456 patients received further adjuvant treatment. Of these patients, 135 received postoperative radiotherapy(S + R group), 113 adjuvant chemotherapy or tamoxifen(S + Y group), and 208 adjuvant chemotherapy or tamoxifen plus radiotherapy(S + Y + R group). Here, chemotherapy plus tomoxifen is designated as systematically therapy. The locoregional recurrence (LRR), disease-free survival (DFS), and overall survival (OS) rates were calculated by Kaplan-Meier analysis. The differences in locoregional recurrence and survival between these groups were compared by logrank test.

RESULTS

The 10-year actuarial LRR, OS and DFS rates for all patients were 13.4%, 81.6%, and 67.6%, respectively. The 10-year LRR rate was 10.3% for patients with negative axillary nodes, 9.4% for those with 1-3 positive nodes, and 25.9% for those with four or more positive nodes. The locoregional recurrence was significantly higher in patients with four or more positive nodes as compared to those with negative or 1-3 positive nodes (P < 0.05). For the S and S + R groups, the 10-year actuarial LRR rate was 18.7% in the S group and 7.5% in the S + R group (P = 0.017), the corresponding OS and DFS rates of these two groups were 82.1% and 81.1% (P = 0.618), and 65.2% and 71.6% (P = 0.457), respectively. For the S + Y and S + Y + R groups, the 10-year actuarial LRR rate was 21.1% in the S + Y group and 9.5% in the S + Y + R group (P = 0.001), There, the corresponding OS and DFS rates were 75.5% and 85.0% (P = 0.020), and 59.3% and 70.2% (P = 0.003), respectively. Only for patients with four or more positive nodes who had had systematic therapy, radiotherapy was beneficial; the 10-year actuarial LRR of patients who received systematic therapy only was 40.1% as compared with 15.1% of those who received systematic therapy plus radiotherapy; Their OS rates were 55.4% and 67.1% (P = 0.040) and their DFS rates were 30.5% and 57.3% (P = 0.001).

CONCLUSION

Post-mastectomy radiotherapy is able to significantly decrease the locoregional recurrence and improve the survival of patients with four or more positive axillary nodes. We suggest that postmastectomy radiotherapy be given as routine for these patients.

摘要

目的

探讨早期乳腺癌乳房切除术后放疗的价值。

方法

1983年至1991年，我院对605例T1-2N0-1M0乳腺癌患者实施了根治性乳房切除术。149例患者仅接受手术（S组），其余456例患者接受了进一步的辅助治疗。其中，135例接受术后放疗（S + R组），113例接受辅助化疗或他莫昔芬治疗（S + Y组），208例接受辅助化疗或他莫昔芬联合放疗（S + Y + R组）。此处，化疗加他莫昔芬被指定为系统治疗。采用Kaplan-Meier分析计算局部区域复发（LRR）、无病生存率（DFS）和总生存率（OS）。通过对数秩检验比较这些组之间局部区域复发和生存率的差异。

结果

所有患者的10年精算LRR、OS和DFS率分别为13.4%、81.6%和67.6%。腋窝淋巴结阴性患者的10年LRR率为10.3%，1-3个阳性淋巴结患者为9.4%，4个或更多阳性淋巴结患者为25.9%。4个或更多阳性淋巴结患者的局部区域复发明显高于阴性或1-3个阳性淋巴结患者（P < 0.05）。对于S组和S + R组，S组的10年精算LRR率为18.7%，S + R组为7.5%（P = 0.017），这两组相应的OS和DFS率分别为82.1%和81.1%（P = 0.618），以及65.2%和71.6%（P = 0.457）。对于S + Y组和S + Y + R组，S + Y组的10年精算LRR率为21.1%，S + Y + R组为9.5%（P = 0.001），相应的OS和DFS率分别为75.5%和85.0%（P = 0.020），以及59.3%和70.2%（P = 0.003）。仅对于接受过系统治疗且有4个或更多阳性淋巴结的患者，放疗是有益的；仅接受系统治疗的患者10年精算LRR为40.1%，而接受系统治疗加放疗的患者为15.1%；他们的OS率分别为55.4%和67.1%（P = 0.040），DFS率分别为30.5%和57.3%（P = 0.001）。