乳腺癌新辅助化疗后降期的患者改良根治术后放射治疗的疗效分析
发布时间：2018-12-15 07:23
【摘要】：目的:探讨放射治疗(简称放疗)在乳腺癌新辅助化疗后同时由(临床分期)T3-4降期为(病理分期)T0-2、由N2-3降期为N0-1、N1降为N0的改良根治术后患者的疗效。材料与方法:回顾性分析103例2005年1月1日至2010年12月31在广西医科大学附属肿瘤医院接受了新辅助化疗(NAC)后同时由T3-4降期为T0-2、由N2-3降期为N0-1、N1降为N0的改良根治术后的乳腺癌患者的临床病例资料。根据患者分期分为三组:T3-4降期为T0-2组(43例)、N2-3降期为N0-1组(33例)、N1降期为N0组(27例)。又根据患者是否接受术后放疗,分为放疗组(42例),未放疗组(61例)。比较各组患者5年无局部复发生存率(LRRFS)、5年无远处转移生存率(DDFS)、5年无进展生存率(DFS)、5年总生存率(OS)。并探索影响乳腺癌患者预后的高危因素。结果:中位随访时间为93(30-132)个月。放疗能提高由T3-4降期为T0-2患者的5年LRRFS、DFS,差异有统计学意义,5年DDFS、OS无统计学差异;放疗能提高由N2-3降期为N1患者的5年全部生存指标,差异有统计学意义,但对N2-3降期为N0患者的5年生存指标无明显影响,差异无统计学意义;放疗对N1降为N0患者的5年生存指标无明显影响,差异无统计学意义。多因素分析提示,术后放疗是T3-4降期为T0-2组患者LRRFS、DFS的独立预后因素,放疗患者的局部复发及进展风险明显低于未放疗患者,但术后放疗不是该组患者DDFS、OS的预后因素。术后放疗是N2-3降期为N1患者的LRRFS、DDFS、DFS、OS的独立预后因素,放疗患者的局部区域复发、远处转移、进展及死亡风险明显低于未放疗患者。术后放疗不是N1-3降期为N0患者生存指标的预后因素。结论:术后放疗能提高新辅助化疗后由T3-4降期为T0-2的乳腺癌改良根治术后患者的5年LRRFS、DFS,能提高由N2-3降期为N1患者的5年LRRFS、DDFS、DFS、OS。放疗对N1-3降为N0患者的5年生存指标无明显影响,因此,对于新辅助化疗后由N1-3降期为N0的乳腺癌改良根治术后患者是否行辅助放疗,仍需进一步扩大样本、多中心、前瞻性的研究。
[Abstract]:Objective: to investigate the effect of radiotherapy on patients with breast cancer after neoadjuvant chemotherapy from T3-4 to T0-2, and from N2-3 to N0-1. Effect of modified radical mastectomy with N 1 reduction to N 0. Materials and methods: from January 1, 2005 to December 31, 2010, 103 patients were treated with neoadjuvant chemotherapeutic (NAC) from January 1, 2005 to December 31, 2010, and then decreased from T3-4 to T0-2, from N2-3 to N0-1, respectively. Clinical data of patients with breast cancer after modified radical mastectomy with N 1 reduction to N 0. According to the stage of the patients, they were divided into three groups: group T3-4, group T0-2 (43 cases), group N2-3, group N0-1 (33 cases), group N1, group N0 (27 cases). The patients were divided into radiotherapy group (42 cases) and non-radiotherapy group (61 cases) according to whether they received postoperative radiotherapy or not. 5-year recurrence free survival rate (LRRFS), 5-year distant metastasis survival rate (DDFS), 5-year progressive survival rate (DFS), 5-year overall survival rate (OS). And to explore the high-risk factors affecting the prognosis of breast cancer patients. Results: the median follow-up time was 93 (30-132) months. Radiotherapy could improve the 5-year LRRFS,DFS, of patients from T3-4 to T0-2, but there was no significant difference in 5-year DDFS,OS. Radiotherapy could improve the 5-year survival index of N1 patients from N2-3 to N1, the difference was statistically significant, but had no significant effect on 5-year survival index of N2-3-N0 patients, and the difference was not statistically significant. Radiotherapy had no significant effect on 5-year survival index in N-0 patients. Multivariate analysis showed that postoperative radiotherapy was an independent prognostic factor of LRRFS,DFS in group T3-4 and T0-2. The risk of local recurrence and progression in patients with radiotherapy was significantly lower than that in patients without radiotherapy, but postoperative radiotherapy was not DDFS, in this group. Prognostic factors of OS. Postoperative radiotherapy was an independent prognostic factor in patients with N1 in N2-3 stage. The regional recurrence, distant metastasis, progression and death risk in patients with radiotherapy were significantly lower than those in patients without radiotherapy. Postoperative radiotherapy was not a prognostic factor for survival index of N 0 patients. Conclusion: postoperative radiotherapy can improve the 5-year LRRFS,DFS, of patients with breast cancer after modified radical mastectomy from T3-4 to T0-2 after neoadjuvant chemotherapy. It can increase the 5-year LRRFS,DDFS,DFS,OS. of patients from N2-3 to N1. Radiotherapy had no significant effect on the 5-year survival index of patients with N1-3 to N0. Therefore, it is necessary to further expand the sample and multicenter whether the patients undergoing modified radical mastectomy after neoadjuvant chemotherapy with N1-3 down to N0 are receiving adjuvant radiotherapy. Prospective research.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9
本文编号：2380246
[Abstract]:Objective: to investigate the effect of radiotherapy on patients with breast cancer after neoadjuvant chemotherapy from T3-4 to T0-2, and from N2-3 to N0-1. Effect of modified radical mastectomy with N 1 reduction to N 0. Materials and methods: from January 1, 2005 to December 31, 2010, 103 patients were treated with neoadjuvant chemotherapeutic (NAC) from January 1, 2005 to December 31, 2010, and then decreased from T3-4 to T0-2, from N2-3 to N0-1, respectively. Clinical data of patients with breast cancer after modified radical mastectomy with N 1 reduction to N 0. According to the stage of the patients, they were divided into three groups: group T3-4, group T0-2 (43 cases), group N2-3, group N0-1 (33 cases), group N1, group N0 (27 cases). The patients were divided into radiotherapy group (42 cases) and non-radiotherapy group (61 cases) according to whether they received postoperative radiotherapy or not. 5-year recurrence free survival rate (LRRFS), 5-year distant metastasis survival rate (DDFS), 5-year progressive survival rate (DFS), 5-year overall survival rate (OS). And to explore the high-risk factors affecting the prognosis of breast cancer patients. Results: the median follow-up time was 93 (30-132) months. Radiotherapy could improve the 5-year LRRFS,DFS, of patients from T3-4 to T0-2, but there was no significant difference in 5-year DDFS,OS. Radiotherapy could improve the 5-year survival index of N1 patients from N2-3 to N1, the difference was statistically significant, but had no significant effect on 5-year survival index of N2-3-N0 patients, and the difference was not statistically significant. Radiotherapy had no significant effect on 5-year survival index in N-0 patients. Multivariate analysis showed that postoperative radiotherapy was an independent prognostic factor of LRRFS,DFS in group T3-4 and T0-2. The risk of local recurrence and progression in patients with radiotherapy was significantly lower than that in patients without radiotherapy, but postoperative radiotherapy was not DDFS, in this group. Prognostic factors of OS. Postoperative radiotherapy was an independent prognostic factor in patients with N1 in N2-3 stage. The regional recurrence, distant metastasis, progression and death risk in patients with radiotherapy were significantly lower than those in patients without radiotherapy. Postoperative radiotherapy was not a prognostic factor for survival index of N 0 patients. Conclusion: postoperative radiotherapy can improve the 5-year LRRFS,DFS, of patients with breast cancer after modified radical mastectomy from T3-4 to T0-2 after neoadjuvant chemotherapy. It can increase the 5-year LRRFS,DDFS,DFS,OS. of patients from N2-3 to N1. Radiotherapy had no significant effect on the 5-year survival index of patients with N1-3 to N0. Therefore, it is necessary to further expand the sample and multicenter whether the patients undergoing modified radical mastectomy after neoadjuvant chemotherapy with N1-3 down to N0 are receiving adjuvant radiotherapy. Prospective research.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9
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