Wu San-Gang, Sun Jia-Yuan, Zhou Juan, Li Feng-Yan, Zhou Hao, Lin Qin, Lin Huan-Xin, Bao Yong, He Zhen-Yu
Xiamen Cancer Center, Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, People's Republic of China.
Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
Radiat Oncol. 2014 Dec 16;9:284. doi: 10.1186/s13014-014-0284-5.
This study was conducted to assess the prognostic value of the number of negative lymph nodes (NLNs) in breast cancer patients with four or more positive lymph nodes after postmastectomy radiotherapy (PMRT).
This retrospective study examined 605 breast cancer patients with four or more positive lymph nodes who underwent mastectomy. A total of 371 patients underwent PMRT. The prognostic value of the NLN count in patients with and without PMRT was analyzed. The log-rank test was used to compare survival curves, and Cox regression analysis was performed to identify prognostic factors.
The median follow-up was 54 months, and the overall 8-year locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were 79.8%, 50.0%, 46.8%, and 57.9%, respectively. The optimal cut-off points for NLN count was 12. Univariate analysis showed that the number of NLNs, lymph node ratio (LNR) and pN stage predicted the LRFS of non-PMRT patients (p<0.05 for all). Multivariate analysis showed that the number of NLNs was an independent prognostic factor affecting the LRFS, patients with a higher number of NLNs had a better LRFS (hazard ratio = 0.132, 95% confidence interval=0.032-0.547, p =0.005). LNR and pN stage had no effect on LRFS. PMRT improved the LRFS (p<0.001), DMFS (p=0.018), DFS (p=0.001), and OS (p=0.008) of patients with 12 or fewer NLNs, but it did not any effect on survival of patients with more than 12 NLNs. PMRT improved the regional lymph node recurrence-free survival (p<0.001) but not the chest wall recurrence-free survival (p=0.221) in patients with 12 or fewer NLNs.
The number of NLNs can predict the survival of breast cancer patients with four or more positive lymph nodes after PMRT.
本研究旨在评估乳房切除术后放疗（PMRT）后有四个或更多阳性淋巴结的乳腺癌患者中阴性淋巴结数量（NLNs）的预后价值。
这项回顾性研究检查了605例接受乳房切除术且有四个或更多阳性淋巴结的乳腺癌患者。共有371例患者接受了PMRT。分析了接受和未接受PMRT患者的NLN计数的预后价值。采用对数秩检验比较生存曲线，并进行Cox回归分析以确定预后因素。
中位随访时间为54个月，总体8年局部区域无复发生存率（LRFS）、远处转移无复发生存率（DMFS）、无病生存率（DFS）和总生存率（OS）分别为79.8%、50.0%、46.8%和57.9%。NLN计数的最佳截断点为12。单因素分析显示，NLNs数量、淋巴结比率（LNR）和pN分期可预测未接受PMRT患者的LRFS（所有p<0.05）。多因素分析显示，NLNs数量是影响LRFS的独立预后因素，NLNs数量较多的患者LRFS更好（风险比=0.132，95%置信区间=0.032 - 0.547，p = 0.005）。LNR和pN分期对LRFS无影响。PMRT改善了NLNs为12个或更少患者的LRFS（p<0.001）、DMFS（p = 0.018）、DFS（p = 0.001）和OS（p = 0.008），但对NLNs超过12个患者的生存无影响。PMRT改善了NLNs为12个或更少患者的区域淋巴结无复发生存率（p<0.001），但未改善胸壁无复发生存率（p = 0.221）。
NLNs数量可预测PMRT后有四个或更多阳性淋巴结的乳腺癌患者的生存情况。
