接受新辅助治疗、手术及放疗的临床IIIc期乳腺癌患者区域淋巴结转移的预后意义
Prognostic significance of nodal involvement region in clinical stage IIIc breast cancer patients who received primary systemic treatment, surgery, and radiotherapy.
作者信息
Noh Jae Myoung, Kim Kyung Hwan, Park Won, Suh Chang Ok, Huh Seung Jae, Choi Doo Ho, Keum Ki Chang, Kim Yong Bae
机构信息
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea.
Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
出版信息
Breast. 2015 Oct;24(5):637-41. doi: 10.1016/j.breast.2015.07.016. Epub 2015 Aug 14.
OBJECTIVES
To evaluate the prognostic influence of involvement of both internal mammary nodes (IMNs) and supraclavicular nodes (SCNs) in clinical stage IIIc breast cancer patients who underwent primary systemic treatment, surgery, and radiotherapy (RT).
MATERIALS AND METHODS
Between 2001 and 2009, 110 breast cancer patients with IMN or SCN involvement were treated with primary systemic treatment followed by surgery and RT. The median age was 50 years. Clinical N-stage was cN3b and cN3c in 29 (26.4%) and 81 (73.6%) patients, respectively. Among the 81 patients with cN3c disease, 18 patients had both IMN and SCN involvement. Primary systemic treatment regimen was most commonly doxorubicin plus docetaxel (54.5%) or cyclophosphamide (20.0%). Mastectomy was performed in 71 (64.5%) patients. The RT dose delivered to the chest wall or whole breast was 50-50.4 Gy in 25-28 fractions. IMN and SCN regions were irradiated in 77 (70.0%) and 107 (97.6%) patients, respectively.
RESULTS
At a median follow-up of 57.4 months (range, 8.6-149.9 months), 44 patients (40.0%) developed disease recurrence. Among the 18 patients with both IMN and SCN involvement, 12 patients experienced disease recurrence and 11 of them had distant metastases. The 5-year disease-free survival (DFS) and overall survival (OS) of all patients were 60.2% and 75.5%, respectively. Decreased DFS and OS were observed in the 18 patients with both IMN and SCN involvement (5-year rates, 33.3% and 50.0%; P = 0.0051 and 0.0010, respectively).
CONCLUSION
Involvement of both IMNs and SCNs was associated with worse survival outcomes in patients with clinical stage IIIc breast cancer.
目的
评估内乳淋巴结（IMNs）和锁骨上淋巴结（SCNs）均受累对接受了初始全身治疗、手术及放疗（RT）的临床Ⅲc期乳腺癌患者预后的影响。
材料与方法
2001年至2009年间，110例IMN或SCN受累的乳腺癌患者接受了初始全身治疗，随后进行手术及RT。中位年龄为50岁。临床N分期中，29例（26.4%）患者为cN3b，81例（73.6%）患者为cN3c。在81例cN3c疾病患者中，18例患者IMN和SCN均受累。初始全身治疗方案最常用的是阿霉素加多西他赛（54.5%）或环磷酰胺（20.0%）。71例（64.5%）患者接受了乳房切除术。胸壁或全乳的RT剂量为50 - 50.4 Gy，分25 - 28次给予。分别有77例（70.0%）和107例（97.6%）患者接受了IMN和SCN区域的照射。
结果
中位随访57.4个月（范围8.6 - 149.9个月）时，44例患者（40.0%）出现疾病复发。在18例IMN和SCN均受累的患者中，12例患者出现疾病复发，其中11例发生远处转移。所有患者的5年无病生存率（DFS）和总生存率（OS）分别为60.2%和75.5%。IMN和SCN均受累的18例患者的DFS和OS降低（5年率分别为33.3%和50.0%；P分别为0.0051和
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