Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
BMC Cancer. 2020 Nov 23;20(1):1132. doi: 10.1186/s12885-020-07594-7.
Previous studies have revealed that nearly 15-20% of selected high-risk T1-2N0 breast cancers developed LRR after mastectomy. This study is aim to indentify the risk factors of locoregional recurrence (LRR) in patients with pathologic T1-2N0 breast cancer after mastectomy in a real-world and distinguish individuals who warrant postmastectomy radiotherapy (PMRT).
Female patients treated from 1999 to 2014 in National Cancer Center of China were retrospectively reviewed. A competing risk model was developed to estimate the cumulative incidence of LRR with death treated as a competing event.
A total of 4841 patients were eligible. All underwent mastectomy plus axillary nodes dissection or sentinel node biopsy without PMRT. With a median follow-up of 56.4 months (range, 1-222 months), the 5-year LRR rate was 3.9%.Besides treatment era, age ≤ 40 years old (p < 0.001, hazard ratio [HR] = 2.262), tumor located in inner quadrant (p < 0.001, HR = 2.236), T2 stage (p = 0.020, HR = 1.419), and negative expressions of estrogen receptor (ER) and progesterone receptor (PR) (p = 0.032, HR = 1.485), were patients-related independent risk factors for LRR. The 5-year LRR rates were 1.7, 3.5, and 15.0% for patients with zero, 1-2, and 3-4 risk factors (p < 0.001).
Risk Stratification based on age, T stage, ER/PR status and tumor location can stratify patients with pT1-2 N0 breast cancer into subgroups with different risk of LRR. PMRT might be suggested for patients with 3-4 risk factors.
先前的研究表明，在选择的高危 T1-2N0 乳腺癌患者中，近 15-20%在乳房切除术后发生局部区域复发（LRR）。本研究旨在确定中国国家癌症中心 1999 年至 2014 年期间接受治疗的 T1-2N0 乳腺癌患者乳房切除术后局部区域复发（LRR）的危险因素，并区分需要接受乳房切除术后放疗（PMRT）的个体。
回顾性分析了在中国国家癌症中心接受治疗的女性患者。采用竞争风险模型估计 LRR 的累积发生率，将死亡作为竞争事件进行处理。
共纳入 4841 例患者。所有患者均接受了乳房切除术加腋窝淋巴结清扫或前哨淋巴结活检，未行 PMRT。中位随访时间为 56.4 个月（范围为 1-222 个月），5 年 LRR 率为 3.9%。除治疗时代外，年龄≤40 岁（p<0.001，风险比[HR]＝2.262）、肿瘤位于内象限（p<0.001，HR＝2.236）、T2 期（p＝0.020，HR＝1.419）以及雌激素受体（ER）和孕激素受体（PR）阴性表达（p＝0.032，HR＝1.485）是与 LRR 相关的患者相关独立危险因素。无、1-2、3-4 个危险因素的患者 5 年 LRR 率分别为 1.7%、3.5%和 15.0%（p<0.001）。
基于年龄、T 分期、ER/PR 状态和肿瘤位置的风险分层可将 T1-2N0 乳腺癌患者分为具有不同 LRR 风险的亚组。对于具有 3-4 个危险因素的患者，建议行 PMRT。
