Wu San-Gang, He Zhen-Yu, Li Feng-Yan, Wang Jun-Jie, Guo Jun, Lin Qin, Guan Xun-Xing
State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, PR China.
Chin J Cancer. 2010 Jul;29(7):668-76. doi: 10.5732/cjc.009.10744.
The role of postmastectomy radiotherapy (PMRT) in breast cancer patients with T1-T2 tumors and 1-3 positive axillary nodes is still uncertain. This study investigated the value of PMRT for these patients.
In the retrospective data of 488 eligible patients, survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate analyses were performed using a log-rank test and the Cox proportional hazards model, respectively.
The median observation time was 54 months. The 5- and 10-year locoregional recurrence-free survival (LRFS) rates were 90.8% and 86.9%, respectively. The 5- and 10-year disease-free survival (DFS) rates were 82.0% and 74.3%, respectively. The 5- and 10-year overall survival (OS) rates were 90.7% and 82.7%, respectively. For the 412 patients without PMRT, T2 classification, 2-3 positive nodes, and hormone (estrogen and progesterone) receptor-negative were risk factors for locoregional recurrence in the multivariate analysis. On the basis of these 3 risk factors, the group with 2-3 factors had a 10-year LRFS rate of 63.1% compared with 96.1% for the group with 0-1 factors (P < 0.001). For the group with 2-3 risk factors, LRFS and DFS were significantly improved by PMRT, with the 5- and 10-year LRFS rates without PMRT of 82.4% and 63.1%, respectively, and, with PMRT, of 98.1% at both 5 years and 10 years (P = 0.002). The 5- and 10-year DFS rates without PMRT were 72.0% and 57.6%, respectively, and, with PMRT, the 5- and 10-year DFS rates were 89.4% and 81.7%, respectively (P = 0.007). There was no significant difference in the 10-year OS rates between patients with and without PMRT. However, there is the potential benefit of 15.3% (87.1% vs. 71.8%, P = 0.072). Conversely, the group with 0-1 factors of PMRT had no effect on prognosis.
In patients receiving mastectomy with T1-T2 breast cancer with 1-3 positive nodes, for the group with 2-3 risk factors, PMRT significantly improved LRFS and DFS and has potential benefit in OS.
保乳术后放疗（PMRT）在T1 - T2期肿瘤且腋窝淋巴结1 - 3个阳性的乳腺癌患者中的作用仍不确定。本研究探讨了PMRT对这些患者的价值。
在488例符合条件患者的回顾性数据中，采用Kaplan - Meier法进行生存分析。分别使用对数秩检验和Cox比例风险模型进行单因素和多因素分析。
中位观察时间为54个月。5年和10年局部区域无复发生存率（LRFS）分别为90.8%和86.9%。5年和10年无病生存率（DFS）分别为82.0%和74.3%。5年和10年总生存率（OS）分别为90.7%和82.7%。对于412例未接受PMRT的患者，多因素分析显示T2分级、2 - 3个阳性淋巴结以及激素（雌激素和孕激素）受体阴性是局部区域复发的危险因素。基于这3个危险因素，有2 - 3个因素的组10年LRFS率为63.1%，而有0 - 1个因素的组为96.1%（P < 0.001）。对于有2 - 3个危险因素的组，PMRT显著改善了LRFS和DFS，未接受PMRT时5年和10年LRFS率分别为82.4%和63.1%，接受PMRT时5年和10年LRFS率均为98.1%（P = 0.002）。未接受PMRT时5年和10年DFS率分别为72.0%和57.6%，接受PMRT时5年和10年DFS率分别为89.4%和81.7%（P = 0.007）。接受和未接受PMRT的患者10年OS率无显著差异。然而，有15.3%的潜在获益（87.1%对71.8%，P = 0.072）。相反，有0 - 1个因素接受PMRT的组对预后无影响。
在接受T1 - T2期乳腺癌保乳手术且腋窝淋巴结1 - 3个阳性的患者中，对于有2 - 3个危险因素的组，PMRT显著改善了LRFS和DFS，且在OS方面有潜在获益。
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