Zhang Yanyu, Zhang Yaotian, Liu Zhuang, Qin Zilan, Li Yubing, Zhao Jiaming, Ma Xinchi, Yang Qiankun, Han Ning, Zeng Xue, Guo Hong, Zhang Na
Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang Liaoning 110042, China.
Department of Bone and Soft Tissue Tumour Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, China.
J Oncol. 2021 Jan 24;2021:6632635. doi: 10.1155/2021/6632635. eCollection 2021.
The impact of postmastectomy radiotherapy (PMRT) in patients receiving neoadjuvant chemotherapy (NAC) is unclear. The purpose of this study is to identify the patients who may benefit from PMRT.
We retrospectively analysed patients with clinical stage II-III breast cancer who underwent NAC and modified radical mastectomy at our centre from 2007 to 2015. We investigated the relationship amongst locoregional recurrence rate (LRR), disease-free survival (DFS), and clinical pathological characters.
A total of 554 patients were analysed in this study. The median follow-up time was 65 months. Amongst the patients, 58 (10.5%) had locoregional recurrence, 138 (24.9%) had distant metastasis, and 72 (13.0%) patients died. The 5-year cumulative incidence of LRR and DFS was 9.2% and 74.2%, respectively. A total of 399 (72%) patients received PMRT and 155 (28%) did not. The 5-year LRR of the patients with PMRT (7.3% vs. 14.1%, =0.01) decreased significantly. We found that PMRT was an independent prognostic factor of LRR and DFS. Patients with the persistent involvement of 1-3 lymph nodes (ypN1) and more than 4 positive lymph nodes (ypN2-3) had a better outcome after PMRT than those without. However, the LRR and DFS of patients with negative lymph nodes at the time of surgery (ypN0) and who received PMRT showed no significant benefits. Amongst all patients with the three molecular subtypes of breast cancer, patients with triple-negative breast cancer had the highest pathological complete response rate but the worst prognosis (=0.001).
Results showed that PMRT significantly reduced the LRR of patients with clinical stage II-III breast cancer after receiving NAC and mastectomy. YpN0 patients derived no local control or survival benefit after receiving PMRT, whereas those with ypN1 and ypN2-3 could obviously benefit from PMRT.
新辅助化疗（NAC）患者接受乳房切除术后放疗（PMRT）的影响尚不清楚。本研究的目的是确定可能从PMRT中获益的患者。
我们回顾性分析了2007年至2015年在本中心接受NAC和改良根治性乳房切除术的II-III期临床乳腺癌患者。我们研究了局部区域复发率（LRR）、无病生存期（DFS）和临床病理特征之间的关系。
本研究共分析了554例患者。中位随访时间为65个月。在这些患者中，58例（10.5%）发生局部区域复发，138例（24.9%）发生远处转移，72例（13.0%）患者死亡。LRR和DFS的5年累积发生率分别为9.2%和74.2%。共有399例（72%）患者接受了PMRT，155例（28%）未接受。接受PMRT的患者5年LRR显著降低（7.3%对14.1%，P=0.01）。我们发现PMRT是LRR和DFS独立的预后因素。1-3个淋巴结持续受累（ypN1）和4个以上阳性淋巴结（ypN2-3）的患者接受PMRT后的结局比未接受者更好。然而，手术时淋巴结阴性（ypN0）且接受PMRT的患者的LRR和DFS未显示出显著获益。在所有具有三种分子亚型的乳腺癌患者中，三阴性乳腺癌患者的病理完全缓解率最高，但预后最差（P=0.001）。
结果表明，PMRT显著降低了II-III期临床乳腺癌患者接受NAC和乳房切除术后的LRR。ypN0患者接受PMRT后未获得局部控制或生存获益，而ypN1和ypN2-3患者可明显从PMRT中获益。
