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T1-2N1 三阴性乳腺癌患者的保乳治疗与乳房切除术的比较:KROG 14-18 和 14-23 的汇总分析。

Breast Conservation Therapy Versus Mastectomy in Patients with T1-2N1 Triple-Negative Breast Cancer: Pooled Analysis of KROG 14-18 and 14-23.

机构信息

Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea.

Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Korea.

出版信息

Cancer Res Treat. 2018 Oct;50(4):1316-1323. doi: 10.4143/crt.2017.575. Epub 2018 Jan 8.

DOI:10.4143/crt.2017.575
PMID:29334604
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6192926/
Abstract

PURPOSE

The aim of this study is to compare the treatment outcomes of breast conserving surgery (BCS) plus radiotherapy (RT) versus mastectomy for patients with pT1-2N1 triple-negative breast cancer (TNBC).

MATERIALS AND METHODS

Using two multicenter retrospective studies on breast cancer, a pooled analysis was performed among 320 patients with pT1-2N1 TNBC. All patients who underwent BCS (n=212) receivedwhole breast RTwith orwithoutregional nodal RT,while nonewho underwent mastectomy (n=108)received it. All patients received taxane-based adjuvant chemotherapy. The median follow-up periods were 65 months in the BCS+RT group, and 74 months in the mastectomy group.

RESULTS

The median age of all patients was 48 years (range, 24 to 70 years). Mastectomy group had more patients with multiple tumors (p < 0.001), no lymphovascular invasion (p=0.001), higher number of involved lymph node (p=0.028), and higher nodal ratio ≥ 0.2 (p=0.037). Other characteristics were not significantly different between the two groups. The 5-year locoregionalrecurrence-free, disease-free, and overall survivalrates of BCS+RT group versus mastectomy group were 94.6% versus 87.7%, 89.5% versus 80.4%, and 95.0% versus 87.8%, respectively, and the differences were statistically significant after adjusting for covariates (p=0.010, p=0.006, and p=0.005, respectively).

CONCLUSION

In pT1-2N1 TNBC, breast conservation therapy achieved better locoregional recurrencefree, disease-free, and overall survival rates compared with mastectomy.

摘要

目的

本研究旨在比较保乳手术(BCS)加放疗(RT)与乳房切除术治疗 pT1-2N1 三阴性乳腺癌(TNBC)患者的治疗效果。

材料和方法

利用两项关于乳腺癌的多中心回顾性研究,对 320 例 pT1-2N1 TNBC 患者进行了汇总分析。所有接受 BCS(n=212)的患者均接受全乳 RT 治疗,其中部分患者还接受区域淋巴结 RT 治疗,而接受乳房切除术(n=108)的患者均未接受 RT 治疗。所有患者均接受紫杉烷类辅助化疗。BCS+RT 组的中位随访时间为 65 个月,乳房切除术组为 74 个月。

结果

所有患者的中位年龄为 48 岁(范围:24 至 70 岁)。与 BCS+RT 组相比,乳房切除术组患者的肿瘤数量更多(p<0.001),无脉管侵犯(p=0.001),淋巴结受累数量更多(p=0.028),淋巴结比值≥0.2(p=0.037)。其他特征两组间无显著差异。BCS+RT 组与乳房切除术组的 5 年局部区域无复发生存率、无病生存率和总生存率分别为 94.6%比 87.7%、89.5%比 80.4%和 95.0%比 87.8%,校正协变量后差异具有统计学意义(p=0.010、p=0.006 和 p=0.005)。

结论

在 pT1-2N1 TNBC 中,与乳房切除术相比,保乳治疗可获得更好的局部区域无复发生存率、无病生存率和总生存率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/896a/6192926/cb53e8f9e9ff/crt-2017-575f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/896a/6192926/cb53e8f9e9ff/crt-2017-575f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/896a/6192926/cb53e8f9e9ff/crt-2017-575f1.jpg

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本文引用的文献

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Lymphovascular invasion as a negative prognostic factor for triple-negative breast cancer after surgery.淋巴管浸润作为三阴性乳腺癌术后的不良预后因素。
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Prognostic Impact of Elective Supraclavicular Nodal Irradiation for Patients with N1 Breast Cancer after Lumpectomy and Anthracycline Plus Taxane-Based Chemotherapy (KROG 1418): A Multicenter Case-Controlled Study.保乳术后蒽环类联合紫杉类化疗的 N1 期乳腺癌患者选择性锁骨上淋巴结照射的预后影响(KROG 1418):一项多中心病例对照研究。
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保乳治疗与改良根治术相比,无论临床淋巴结阳性还是阴性的乳腺癌患者,均能改善生存而不增加局部区域复发的风险。
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