Kim Kyubo, Jung Jinhong, Kim Haeyoung, Jung Wonguen, Shin Kyung Hwan, Chang Ji Hyun, Kim Su Ssan, Park Won, Chang Jee Suk, Kim Yong Bae, Ahn Sung Ja, Lee Ik Jae, Lee Jong Hoon, Park Hae Jin, Cha Jihye, Kim Juree, Choi Jin Hwa, Koo Taeryool, Kwon Jeanny, Kim Jin Hee, Kim Mi Young, Park Shin-Hyung, Kim Yeon-Joo
Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea.
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Cancer Res Treat. 2022 Apr;54(2):497-504. doi: 10.4143/crt.2021.933. Epub 2021 Aug 25.
To evaluate the role of postmastectomy radiation therapy (PMRT) in patients with node-negative breast cancer of 5cm or larger tumors undergoing mastectomy.
Medical records of 274 patients from 18 institutions treated with mastectomy between January 2000 and December 2016 were retrospectively reviewed. Among these, 202 patients underwent PMRT, while 72 did not. Two hundred and forty-one patients (88.0%) received systemic chemotherapy, and 172 (62.8%) received hormonal therapy. Patients receiving PMRT were younger, more likely to have progesterone receptor-positive tumors, and received adjuvant chemotherapy more frequently compared with those without PMRT (p <0.001, 0.018, and <0.001, respectively). Other characteristics were not significantly different between the two groups.
With a median follow-up of 95 months (range, 1-249), there were 9 locoregional recurrences, and 20 distant metastases. The 8-year locoregional recurrence-free survival rates were 98.0% with PMRT and 91.3% without PMRT (p=0.133), and the 8-year disease-free survival (DFS) rates were 91.8% with PMRT and 73.9% without PMRT (p=0.008). On multivariate analysis incorporating age, histologic grade, lymphovascular invasion, hormonal therapy, chemotherapy, and PMRT, the absence of lymphovascular invasion and the receipt of PMRT were associated with improved DFS (p=0.025 and 0.009, respectively).
Locoregional recurrence rate was very low in node-negative breast cancer of 5cm or larger tumors treated with mastectomy regardless of the receipt of PMRT. However, PMRT was significantly associated with improved DFS. Further investigation is needed to confirm these findings.
评估乳房切除术后放射治疗（PMRT）在接受乳房切除术的肿瘤大小为5厘米或更大的淋巴结阴性乳腺癌患者中的作用。
回顾性分析了2000年1月至2016年12月期间18家机构接受乳房切除术的274例患者的病历。其中，202例患者接受了PMRT，72例未接受。241例患者（88.0%）接受了全身化疗，172例（62.8%）接受了激素治疗。与未接受PMRT的患者相比，接受PMRT的患者更年轻，更有可能患有孕激素受体阳性肿瘤，且更频繁地接受辅助化疗（p分别<0.001、0.018和<0.001）。两组的其他特征无显著差异。
中位随访95个月（范围1 - 249个月），有9例局部区域复发和20例远处转移。接受PMRT的患者8年局部区域无复发生存率为98.0%，未接受PMRT的患者为91.3%（p = 0.133），接受PMRT的患者8年无病生存率（DFS）为91.8%，未接受PMRT的患者为73.9%（p = 0.008）。在纳入年龄、组织学分级、淋巴管浸润、激素治疗、化疗和PMRT的多因素分析中，无淋巴管浸润和接受PMRT与DFS改善相关（p分别为0.025和0.009）。
无论是否接受PMRT，接受乳房切除术的肿瘤大小为5厘米或更大的淋巴结阴性乳腺癌患者的局部区域复发率都非常低。然而，PMRT与DFS改善显著相关。需要进一步研究来证实这些发现。
