Department of Radiation Oncology, the University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Int J Radiat Oncol Biol Phys. 2011 Nov 1;81(3):782-7. doi: 10.1016/j.ijrobp.2010.06.027. Epub 2011 Aug 30.
The purpose of this study was to determine local-regional recurrence (LRR) risk according to whether postmastectomy radiation therapy (PMRT) was used to treat breast cancer patients with clinical T3N0 disease who received neoadjuvant chemotherapy (NAC) and mastectomy.
Clinicopathology data from 162 patients with clinical T3N0 breast cancer who received NAC and underwent mastectomy were retrospectively reviewed. A total of 119 patients received PMRT, and 43 patients did not. The median number of axillary lymph nodes (LNs) dissected was 15. Actuarial rates were calculated using the Kaplan-Meier method and compared using the log-rank test.
At a median follow-up of 75 months, 15 of 162 patients developed LRR. For all patients, the 5-year LRR rate was 9% (95% confidence interval [CI], 4%-14%). The 5-year LRR rate for those who received PMRT was 4% (95% CI, 1%-9%) vs. 24% (95% CI, 10%-39%) for those who did not receive PMRT (p <0.001). A significantly higher proportion of irradiated patients had pathology involved LNs and were ≤40 years old. Among patients who had pathology involved LNs, the LRR rate was lower in those who received PMRT (p <0.001). A similar trend was observed for those who did not have pathology involved LN disease. Among nonirradiated patients, the appearance of pathologic LN disease after NAC was the only clinicopathologic factor examined that significantly correlated with the risk of LRR.
Breast cancer patients with clinical T3N0 disease treated with NAC and mastectomy but without PMRT had a significant risk of LRR, even when there was no pathologic evidence of LN involvement present after NAC. PMRT was effective in reducing the LRR rate. We suggest PMRT should be considered for patients with clinical T3N0 disease.
本研究旨在确定接受新辅助化疗（NAC）和乳房切除术的临床 T3N0 乳腺癌患者中，是否行术后放疗（PMRT）治疗与局部区域复发（LRR）风险的关系。
回顾性分析了 162 例接受 NAC 和乳房切除术的临床 T3N0 乳腺癌患者的临床病理数据。共有 119 例患者接受了 PMRT，43 例患者未接受。腋窝淋巴结（LNs）清扫的中位数为 15 枚。采用 Kaplan-Meier 法计算生存率，并用对数秩检验进行比较。
在中位随访 75 个月时，162 例患者中有 15 例发生 LRR。所有患者的 5 年 LRR 率为 9%（95%置信区间 [CI]，4%-14%）。接受 PMRT 的患者 5 年 LRR 率为 4%（95% CI，1%-9%），而未接受 PMRT 的患者为 24%（95% CI，10%-39%）（p<0.001）。更多接受放疗的患者有病理学 LN 受累且年龄≤40 岁。在有病理学 LN 受累的患者中，接受 PMRT 的患者 LRR 率较低（p<0.001）。在没有病理学 LN 疾病的患者中也观察到类似的趋势。在未接受放疗的患者中，NAC 后出现病理 LN 疾病是唯一与 LRR 风险显著相关的临床病理因素。
接受 NAC 和乳房切除术但未行 PMRT 治疗的临床 T3N0 疾病乳腺癌患者存在显著的 LRR 风险，即使在 NAC 后没有病理学证据表明存在 LN 受累。PMRT 可有效降低 LRR 率。我们建议对临床 T3N0 疾病患者考虑 PMRT。
