Han Xiumei, Jiang Die, Zhu Chaomang, Li Duojie, Yin Hongmei
Department of Radiotherapy, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, 233000, People's Republic of China.
Anhui Provincial Key Laboratory of Tumor Evolution and Intelligent Diagnosis and Treatment, Bengbu Medical University, Bengbu, Anhui, 233000, People's Republic of China.
Breast Cancer (Dove Med Press). 2024 Nov 26;16:811-823. doi: 10.2147/BCTT.S487335. eCollection 2024.
This study aimed to investigate the efficacy and survival analysis of internal mammary lymph nodes (IMLNI) radiotherapy after modified radical mastectomy for TNM The lateral quadrant breast cancer.
A total of 124 patients who underwent adjuvant radiotherapy after modified radical mastectomy for breast cancer in the First Affiliated Hospital of Bengbu Medical University were included. The patients were divided into the internal mammary lymph node (IMLN) irradiation group, and sixty-two patients received postoperative chest wall + upper and infraclavicular lymph nodes + IMLNI,sixty-two patients in the non-IMLN irradiation group received postoperative radiotherapy to the chest wall + upper and infraclavicular lymph nodes. The radiotherapy dose was 45-50GY, The disease-free survival rate (DFS), survival rate (OS), local recurrence rate (LRR), distant metastasis rate (DM), and adverse radiation reactions were analyzed.
Median follow-up was 56 months (range 12-96). The 5-year OS in the IMLNI group and the non-IMLNI group were 80.6% and 79.8% (P>0.05), DFS was 62.9% and 59.7% (P>0.05), LRR was 22.6 and 21.0% (P>0.05), and DM was 25.8% and 33.9% (P>0.05), respectively. Multifactorial showed that T stage, PR status, vascular cancer embolism, it was an independent prognostic factor affecting the 5-year OS of patients, and PR expression status (P=0.038) was an independent prognostic factor affecting the 5-year LRR.
For breast cancer patients located in the outer quadrant and more than 9 axillary lymph node positives, increasing IMNI failed to improve the 5-year prognosis of the patients, and for patients with late N stage, PR receptor-negative, and vascularity cancer thrombosis positive, the 5-year OS of breast cancer postoperative patients could be reduced, and the PR receptor positivity could reduce the 5-year LRR of patients. There was no significant difference in 5-year late radiation adverse effects between the IMLNI and non-IMLNI groups.
本研究旨在探讨TNM外侧象限乳腺癌改良根治术后内乳淋巴结（IMLNI）放疗的疗效及生存分析。
纳入蚌埠医学院第一附属医院124例行乳腺癌改良根治术后辅助放疗的患者。将患者分为内乳淋巴结（IMLN）照射组，62例患者接受术后胸壁+锁骨上及锁骨下淋巴结+IMLNI放疗，非IMLN照射组62例患者接受术后胸壁+锁骨上及锁骨下淋巴结放疗。放疗剂量为45-50GY，分析无病生存率（DFS）、生存率（OS）、局部复发率（LRR）、远处转移率（DM）及放疗不良反应。
中位随访时间为56个月（范围为12-96个月）。IMLNI组和非IMLNI组的5年总生存率分别为80.6%和79.8%（P>0.05），无病生存率分别为62.9%和59.7%（P>0.05），局部复发率分别为22.6%和21.0%（P>0.05），远处转移率分别为25.8%和33.9%（P>0.05）。多因素分析显示，T分期、PR状态、血管癌栓是影响患者5年总生存率的独立预后因素，PR表达状态（P=0.038）是影响5年局部复发率的独立预后因素。
对于位于外象限且腋窝淋巴结转移阳性超过9枚的乳腺癌患者，增加IMNI未能改善患者的5年预后，对于N期晚期、PR受体阴性及血管癌栓阳性的患者，乳腺癌术后患者的5年总生存率可能降低，PR受体阳性可降低患者的5年局部复发率。IMLNI组和非IMLNI组5年晚期放疗不良反应无显著差异。
