Department of Radiation Oncology, University of Miami Miller School of Medicine, Florida, USA.
Cancer. 2013 Jan 1;119(1):16-25. doi: 10.1002/cncr.27717. Epub 2012 Jun 26.
The objective of this study was to identify predictors of locoregional recurrence (LRR) after neoadjuvant therapy (NAT) and postmastectomy radiation (PMRT) in a cohort of patients with stage II through III breast cancer and to determine whether omission of the supraclavicular field had an impact on the risk of LRR.
The authors reviewed records from 464 patients who received NAT and PMRT from January 1999 to December 2009.
The median patient age was 50 years (range, 25-81 years). Clinical disease stage was stage II in 29% of patients, stage III in 71%, and inflammatory in 14%. Receptor status was estrogen receptor (ER)-positive in 54% of patients, progesterone receptor (PR)-positive in 39%, human epidermal growth factor receptor 2 (HER2)-positive in 24%, and negative for all 3 receptors (triple negative) in 32%. All patients received NAT and underwent mastectomy, and 19.6% had a complete pathologic response in the breast and axilla, 17.5% received radiation to the chest wall only, and 82.5% received radiation to the chest wall and the supraclavicular field; omission of the supraclavicular field was more common in patients with lower clinical and pathologic lymph node status. The median follow-up was 50.5 months, and the 5-year cumulative incidence of LRR was 6% (95% confidence interval, 3.9%-8.6%). Predictors of LRR were clinical stage III (P = .038), higher clinical lymph node status (P = .025), higher pathologic lymph node status (P = .003), the combination of clinically and pathologically positive lymph nodes (P < .001), inflammatory presentation (P = .037), negative ER status (P = .006), negative PR status (P = .015), triple-negative status (P < .001), and pathologic tumor size >2 cm (P = .045). On univariate analysis, omission of the supraclavicular field was not associated significantly with LRR (hazard ratio, 0.89; P = .833); however, on multivariate analyses, omission of the supraclavicular field was associated significantly with LRR (hazard ratio, 3.39; P = .024).
Presenting stage, receptor status, pathologic response to neoadjuvant therapy, and omission the supraclavicular field were identified as risk factors for LRR after neoadjuvant therapy and PMRT.
本研究旨在确定接受新辅助治疗（NAT）和乳房切除术+术后放疗（PMRT）的 II 期至 III 期乳腺癌患者局部区域复发（LRR）的预测因素，并确定锁骨上野的省略是否会对 LRR 风险产生影响。
作者回顾了 1999 年 1 月至 2009 年 12 月期间接受 NAT 和 PMRT 的 464 例患者的记录。
中位患者年龄为 50 岁（范围，25-81 岁）。临床疾病分期为 II 期的患者占 29%，III 期的患者占 71%，炎性的患者占 14%。受体状态为雌激素受体（ER）阳性的患者占 54%，孕激素受体（PR）阳性的患者占 39%，人表皮生长因子受体 2（HER2）阳性的患者占 24%，3 种受体均阴性（三阴性）的患者占 32%。所有患者均接受了 NAT 和乳房切除术，19.6%的患者在乳房和腋窝有完全的病理缓解，17.5%的患者仅接受了胸壁放疗，82.5%的患者接受了胸壁和锁骨上野放疗；锁骨上野省略更常见于临床和病理淋巴结状态较低的患者。中位随访时间为 50.5 个月，5 年 LRR 累积发生率为 6%（95%置信区间，3.9%-8.6%）。LRR 的预测因素包括临床 III 期（P=0.038）、较高的临床淋巴结状态（P=0.025）、较高的病理淋巴结状态（P=0.003）、临床和病理阳性淋巴结的组合（P＜0.001）、炎性表现（P=0.037）、ER 状态阴性（P=0.006）、PR 状态阴性（P=0.015）、三阴性状态（P＜0.001）和肿瘤大小＞2cm（P=0.045）。单因素分析显示，锁骨上野省略与 LRR 无显著相关性（风险比，0.89；P=0.833）；然而，多因素分析显示，锁骨上野省略与 LRR 显著相关（风险比，3.39；P=0.024）。
本研究确定了新辅助治疗和 PMRT 后 LRR 的预测因素，包括发病阶段、受体状态、新辅助治疗的病理反应以及锁骨上野省略。
