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2017年6月23日，中华医学会《中华肿瘤杂志》将正式发表国家癌症中心、中国医学科学院北京协和医学院肿瘤医院（荣庆林、王淑莲、唐玉、金晶、宋永文、王维虎、刘跃平、房辉、任骅、刘新帆、余子豪、李晔雄）的研究报告，分析了临床T1～3N1M0期乳腺癌患者经新辅助化疗（NAC）和改良根治术后达到腋窝淋巴结病理阴性（ypN0）患者术后放疗的价值和转归。 该研究回顾分析了1999～2013年中国医学科学院肿瘤医院收治的185例临床诊断为T1～3N1M0期乳腺癌患者的临床资料，所有患者均完成NAC和改良根治术，术后达ypN0。89例行术后放疗，96例未行放疗。Ⅱ期患者101例，Ⅲ期患者84例。采用生存曲线法计算局部区域复发率、远处转移率、无病生存率和总生存率，并行对数秩检验，单因素分析临床特征和治疗对患者转归的影响。 结果发现：
单因素分析结果显示：
Ⅲ期患者中，放疗组与未放疗组相比：
Ⅱ期患者中，放疗组与未放疗组相比：
因此，临床T1～3N1M0期乳腺癌NAC和改良根治术后达到ypN0患者的局部区域复发率较低，术后放疗能明显降低远处转移率并提高无病生存率，并且可以降低临床Ⅲ期患者的局部区域复发率。Ⅲ期患者需要术后放疗，Ⅱ期患者的放疗价值需要进一步研究。 通信作者：李晔雄（yexiong12@163.com） 原文参见：中华肿瘤杂志. 2017;39(6):445-452. Zhonghua Zhong Liu Za Zhi. 2017 Jun 23;39(6):445-452. The role of postmastectomy radiotherapy in clinical T1-3N1M0 breast cancer patients with pathological negative lymph nodes after neoadjuvant chemotherapy and mastectomy. Rong QL, Wang SL, Tang Y, Jin J, Song YW, Wang WH, Liu YP, Fang H, Ren H, Liu XF, Yu ZH, Li YX. National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. OBJECTIVE: To analyze the outcomes of clinical T1-3N1M0 breast cancer patients with pathological negative axillary lymph nodes (ypN0) after neoadjuvant chemotherapy (NAC) and mastectomy, and investigate the role of postmastectomy radiotherapy (PMRT). METHODS: A total of 185 patients with clinical T1-3N1M0 breast cancer treated between 1999 and 2013 were retrospectively reviewed. All patients were treated with NAC and mastectomy, and achieved ypN0. Of them, 89 patients received additional PMRT and 96 patients did not. 101 patients had clinical stage II disease. 84 patients had clinical stage III disease. The rates of locoregional recurrence (LRR), distant metastasis (DM), disease-free survival (DFS), and overall survival (OS) were calculated using the Kaplan-Meier method, and differences were compared using the log-rank test. Univariate analysis was used to interpret the impact of clinical features and treatment on patients' outcome. RESULTS: The 5-year rates of LRR, DM, DFS, and OS for all patients were 4.5%, 10.4%, 86.6%, and 97.1%, respectively. For patients with and without PMRT, the 5-year LRR rates were 1.1% and 7.5% (P=0.071), the 5-year DM rates were 5.1% and 15.0% (P=0.023), the 5-year DFS rates were 95.0% and 79.0% (P=0.008), and the 5-year OS rates were 100.0% and 94.5% (P=0.089) respectively. In univariate analysis, lymph-vascular space invasion (LVSI) was poor prognostic factor of LRR (P=0.001), < 40 years old and lack of PMRT was a poor prognostic factor for DM (P<0.05), lack of PMRT was a poor prognostic factor for DFS (P=0.008), primary lesion residual and mild-moderate pathological response to NAC were poor prognostic factors for OS (P<0.05). In the subgroup of Stage III disease, for patients with and without PMRT, the 5-year LRR rates were 1.9% and 14.4% (P=0.041), the 5-year DFS rates were 91.9% and 67.4% (P=0.022), respectively. In the subgroup of Stage II disease, for patients with and without PMRT, the 5-year DM rates were 0 and 11.5% (P=0.044), the 5-year DFS rates were 100.0% and 84.9% (P=0.023), respectively. CONCLUSIONS: The LRR rate of clinical T1-3N1M0 breast cancer patients who achieved ypN0 after NAC and mastectomy was low. PMRT decreased the DM rate and increased DFS rate in all patients, and significantly decreased the LRR rate in Stage III disease. PMRT should be considered for patients with Stage III disease, and further research is warranted to investigate the benefit of PMRT for Stage II disease. KEYWORDS: Breast neoplasms; Drug therapy; Prognosis; Radiotherapy PMID: 28635235 DOI: 10.3760/cma.j.issn.0253-3766.2017.06.009 |
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