Li Guanqiao, Yao Jia, Chen Junni, Cai Baizhen, Lin Xiangying, Chen Zetan, Chen Jiawei, Wang Han, Yang Shiping
Department of Breast Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China.
Department of Radiation Oncology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China.
Front Oncol. 2021 Jul 12;11:653831. doi: 10.3389/fonc.2021.653831. eCollection 2021.
Peripheral lymphatic radiotherapy in patients with pT3N0M0 and pT4N0M0 breast cancer has been a matter of considerable debate among radiation oncologists. This is the first report in a non-Caucasian population.
The study included 165 pT3N0M0 and pT4N0M0 patients. Univariate, multivariate, propensity score matching (PSM), and Kaplan-Meier analyses were conducted to evaluate the survival of patients. We also review all the literature about regional lymph nodes radiation in T3-4N0M0 patients and summarize them with tables to compare with the present study.
The median follow-up duration was 58.7 months. Multivariate analyses showed that advance T stage and grade were dependent poor prognostic factors for OS, DMFS, LRFS, and DFS between group A (chest wall radiation) and group B (chest wall and regional lymph nodes radiation). The overall survival (OS), disease-free survival (DFS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) rates were not significantly different between group A and group B. The 5-year OS rate was 92.3% 89.7% for group A and group B, respectively (P=0.819). The 5-year LRFS rate was 94.9% 94.3% for group A and group B, respectively (P=0.852). Fifty-four pairs of patients were selected after propensity score matching (PSM) analysis was conducted. There was also no significant difference between group A and group B in regard to the OS, DFS, LRFS, and DMFS rates after PSM. The patients included in previous studies were all Caucasians, and our study was focused on non-Caucasians. The cases of previous studies were 10 to 20 years ago, but our study has more recent cases. The radiotherapy techniques of previous studies were conventional, and the techniques used in our study were three-dimensional conformal radiotherapy (3DCRT) or intensity modulated radiotherapy (IMRT).
Both our study and previous studies suggested that regional lymph nodes radiation cannot improve the survival rate for breast cancer patients with T3-4N0M0 in non-Caucasian population. Advance T stage and grade were the dependent poor prognostic factors for T3-4N0M0 patients.
对于pT3N0M0和pT4N0M0乳腺癌患者，外周淋巴放疗一直是放射肿瘤学家们相当有争议的问题。这是关于非白种人群的首份报告。
该研究纳入了165例pT3N0M0和pT4N0M0患者。进行单因素、多因素、倾向评分匹配（PSM）及Kaplan-Meier分析以评估患者的生存率。我们还回顾了所有关于T3-4N0M0患者区域淋巴结放疗的文献，并用表格进行总结以与本研究作比较。
中位随访时间为58.7个月。多因素分析显示，在A组（胸壁放疗）和B组（胸壁及区域淋巴结放疗）之间，T分期进展和分级是总生存期（OS）、无远处转移生存期（DMFS）、无局部复发生存期（LRFS）和无病生存期（DFS）的不良预后相关因素。A组和B组的总生存期（OS）、无病生存期（DFS）、无局部复发生存期（LRFS）和无远处转移生存期（DMFS）率无显著差异。A组和B组的5年总生存率分别为92.3%和89.7%（P = 0.819）。A组和B组的5年无局部复发生存率分别为94.9%和94.3%（P = 0.852）。在进行倾向评分匹配（PSM）分析后，选择了54对患者。PSM后A组和B组在OS、DFS、LRFS和DMFS率方面也无显著差异。之前研究纳入的患者均为白种人，而我们的研究聚焦于非白种人。之前研究的病例是在10至20年前，而我们的研究有更近的病例。之前研究的放疗技术是传统的，而我们研究中使用的技术是三维适形放疗（3DCRT）或调强放疗（IMRT）。
我们的研究和之前的研究均表明，在非白种人群中，区域淋巴结放疗不能提高T3-4N0M0乳腺癌患者的生存率。T分期进展和分级是T3-4N0M0患者不良预后的相关因素。
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