乳腺癌新輔助化療后降期的患者改良根治術后放射治療的療效分析
發(fā)布時間：2018-12-15 07:23
【摘要】：目的:探討放射治療(簡稱放療)在乳腺癌新輔助化療后同時由(臨床分期)T3-4降期為(病理分期)T0-2、由N2-3降期為N0-1、N1降為N0的改良根治術后患者的療效。材料與方法:回顧性分析103例2005年1月1日至2010年12月31在廣西醫(yī)科大學附屬腫瘤醫(yī)院接受了新輔助化療(NAC)后同時由T3-4降期為T0-2、由N2-3降期為N0-1、N1降為N0的改良根治術后的乳腺癌患者的臨床病例資料。根據(jù)患者分期分為三組:T3-4降期為T0-2組(43例)、N2-3降期為N0-1組(33例)、N1降期為N0組(27例)。又根據(jù)患者是否接受術后放療,分為放療組(42例),未放療組(61例)。比較各組患者5年無局部復發(fā)生存率(LRRFS)、5年無遠處轉移生存率(DDFS)、5年無進展生存率(DFS)、5年總生存率(OS)。并探索影響乳腺癌患者預后的高危因素。結果:中位隨訪時間為93(30-132)個月。放療能提高由T3-4降期為T0-2患者的5年LRRFS、DFS,差異有統(tǒng)計學意義,5年DDFS、OS無統(tǒng)計學差異;放療能提高由N2-3降期為N1患者的5年全部生存指標,差異有統(tǒng)計學意義,但對N2-3降期為N0患者的5年生存指標無明顯影響,差異無統(tǒng)計學意義;放療對N1降為N0患者的5年生存指標無明顯影響,差異無統(tǒng)計學意義。多因素分析提示,術后放療是T3-4降期為T0-2組患者LRRFS、DFS的獨立預后因素,放療患者的局部復發(fā)及進展風險明顯低于未放療患者,但術后放療不是該組患者DDFS、OS的預后因素。術后放療是N2-3降期為N1患者的LRRFS、DDFS、DFS、OS的獨立預后因素,放療患者的局部區(qū)域復發(fā)、遠處轉移、進展及死亡風險明顯低于未放療患者。術后放療不是N1-3降期為N0患者生存指標的預后因素。結論:術后放療能提高新輔助化療后由T3-4降期為T0-2的乳腺癌改良根治術后患者的5年LRRFS、DFS,能提高由N2-3降期為N1患者的5年LRRFS、DDFS、DFS、OS。放療對N1-3降為N0患者的5年生存指標無明顯影響,因此,對于新輔助化療后由N1-3降期為N0的乳腺癌改良根治術后患者是否行輔助放療,仍需進一步擴大樣本、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.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.9
本文編號：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.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.9
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