Truong Pauline T, Jones Stuart O, Kader Hosam A, Wai Elaine S, Speers Caroline H, Alexander Abraham S, Olivotto Ivo A
Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, BC, Canada.
Int J Radiat Oncol Biol Phys. 2009 Feb 1;73(2):357-64. doi: 10.1016/j.ijrobp.2008.04.034.
To evaluate locoregional recurrence according to nodal status in women with T1 to T2 breast cancer and zero to three positive nodes (0-3N+) treated with breast-conserving surgery (BCS).
The study subjects comprised 5,688 women referred to the British Columbia Cancer Agency between 1989 and 1999 with pT1 to T2, 0-3N+, M0 breast cancer, who underwent breast-conserving surgery with clear margins and radiotherapy (RT) of the whole breast. The 10-year Kaplan-Meier local, regional, and locoregional recurrence (LR, RR, and LRR, respectively) were compared between the N0 (n = 4,433) and 1-3N+ (n = 1,255) cohorts. The LRR was also examined in patients with one to three positive nodes (1-3N+) treated with and without nodal RT. Multivariate analysis was performed using Cox regression modeling.
Median follow-up was 8.6 years. Systemic therapy was used in 97% of 1-3N+ and 41% of N0 patients. Nodal RT was used in 35% of 1-3N+ patients. The 10-year recurrence rates in N0 and 1-3N+ cohorts were as follows: LR 5.1% vs. 5.8% (p = 0.04); RR 2.3% vs. 6.1% (p < 0.001), and LRR 6.7% vs. 10.1% (p < 0.001). Among 817 1-3N+ patients treated without nodal RT, 10-year LRR were 13.8% with age <50 years, 20.3% with Grade III, and 23.4% with estrogen receptor (ER)-negative disease. On multivariate analysis, 1-3N+ status was associated with significantly higher LRR (hazard ratio [HR], 1.85; 95% confidence interval, 1.34-2.55, p < 0.001), whereas nodal RT significantly reduced LRR (HR, 0.59; 95% confidence interval, 0.38-0.92, p = 0.02).
Patients with 1-3N+ and young age, Grade III, or ER-negative disease have high LRR risks approximating 15% to 20% despite BCS, whole-breast RT and systemic therapy. These patients may benefit with more comprehensive RT volume encompassing the regional nodes.
评估接受保乳手术（BCS）治疗的T1至T2期乳腺癌且腋窝淋巴结转移0至3枚阳性（0 - 3N +）女性患者的局部区域复发情况与淋巴结状态的关系。
研究对象包括1989年至1999年间转诊至英属哥伦比亚癌症机构的5688例pT1至T2、0 - 3N +、M0期乳腺癌女性患者，这些患者均接受了切缘阴性的保乳手术及全乳放疗（RT）。比较N0组（n = 4433）和1 - 3N +组（n = 1255）的10年Kaplan - Meier局部、区域和局部区域复发率（分别为LR、RR和LRR）。还对接受和未接受区域淋巴结放疗的1至3枚阳性淋巴结（1 - 3N +）患者的LRR进行了检查。使用Cox回归模型进行多因素分析。
中位随访时间为8.6年。1 - 3N +组97%的患者和N0组41%的患者接受了全身治疗。1 - 3N +组35%的患者接受了区域淋巴结放疗。N0组和1 - 3N +组的10年复发率如下：LR分别为5.1%和5.8%（p = 0.04）；RR分别为2.3%和6.1%（p < 0.001），LRR分别为6.7%和10.1%（p < 0.001）。在817例未接受区域淋巴结放疗的1 - 3N +患者中，年龄<50岁患者的10年LRR为13.8%，III级患者为20.3%，雌激素受体（ER）阴性疾病患者为23.4%。多因素分析显示：1 - 3N +状态与显著更高的LRR相关（风险比[HR]，1.85；95%置信区间，1.34 - 2.55，p < 0.001），而区域淋巴结放疗显著降低了LRR（HR，0.59；95%置信区间，0.38 - 0.92，p = 0.02）。
尽管接受了保乳手术、全乳放疗和全身治疗，但1 - 3N +且年龄较小、III级或ER阴性疾病的患者局部区域复发风险较高，接近15%至20%。这些患者可能从更全面的包括区域淋巴结的放疗靶区中获益。
