| 王修身,许 刚,卜珊珊.乳腺癌术后pT1～3N3M0患者锁骨上下淋巴引流区放疗加量的疗效评价[J].中国肿瘤,2020,29(11):891-896. |
| 乳腺癌术后pT1～3N3M0患者锁骨上下淋巴引流区放疗加量的疗效评价 |
| Evaluation of Raised Radiation Dose in Supra/Sub-clavian Lymphatic Drainage Area of Patients with pT1～3N3M0 Breast Cancer After Mastectomy |
| 中文关键词 修订日期：2020-03-30 |
| DOI：10.11735/j.issn.1004-0242.2020.11.A017 |
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| 中文关键词: 乳腺癌 放射治疗 锁骨上淋巴引流区 锁骨下淋巴引流区 局部复发 |
| 英文关键词:breast cancer radiotherapy supraclavicular lymphatic drainage area subclavian lymphatic drainage area local recurrence |
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| 中文摘要: |
| 摘 要：［目的］ 探讨锁骨上下淋巴引流区放疗加量对乳腺癌改良根治术联合同侧锁骨上淋巴结清扫术后pT1～3N3M0患者的3年无病生存率，总生存率及局部复发的影响。［方法］ 回顾性分析2013—2015年郑州大学附属肿瘤医院收治的乳腺癌改良根治术联合同侧锁骨上淋巴结清扫术后患者，入组标准为女性，术后病理为浸润性癌，腋窝淋巴结阳性≥10个，或锁骨上下淋巴结阳性，无远处转移。共收集病例208例，根据治疗方式不同分为两组，每组104例患者，加量组：胸壁及内乳淋巴引流区的放疗剂量为50.4Gy，锁骨上下淋巴引流区的放疗剂量为61.6Gy，分28次同步调强完成；常规照射组：锁骨上下、胸壁及内乳淋巴引流区的放疗剂量为50Gy/25次。Kaplan-Meier法计算锁骨上下淋巴结复发率、无病生存率及总生存率。［结果］中位随访时间为59个月(40～78个月)，加量组和常规照射患者3年锁骨上下复发率分别为11.5%和24.0%，两组相比差异有统计学意义(P<0.05)。N3a患者中加量组及常规照射组的锁骨上下淋巴结的复发率分别为14.5%和20.0%，两组相比差异无统计学意义(P>0.05)。N3c患者中加量组及常规照射组的锁骨上下淋巴结的复发率分别为7.1%和28.6%，两组相比差异有统计学意义(P<0.05)。所有患者加量组和常规照射组3年生存率分别为79.8%和69.2%，3年无病生存率分别为70.1%及64.4%，两组相比差异均无统计学意义(P>0.05)。N3a患者加量组和常规照射组3年生存率分别为80.6%及72.7%，3年无病生存率分别为61.2%和67.2%，两组相比差异均无统计学意义(P>0.05)。N3c患者加量组和常规照射组3年生存率分别为85.7%和65.3%，3年无病生存率分别为83.3%和61.2%，两组相比差异均有统计学意义(P<0.05)。两组患者的不良反应发生率差异无统计学意义(P>0.05)。［结论］ 乳腺癌改良根治术后pT1～3N3M0患者锁骨上下淋巴引流区放疗加量，在N3c患者中可以降低锁骨上下淋巴结复发率，提高3年无病生存率及总生存率。 |
| 英文摘要: |
| Abstract：［Purpose］ To evaluate the efficacy of raised radiation dose in supra/sub-clavian lymphatic drainage area in patients with pT1～3N3M0 breast cancer after modified radical mastectomy and ipsilateral supraclavicular lymphadenectomy. ［Methods］ A retrospective analysis was made for the breast cancer patients who underwent modified radical mastectomy and ipsilateral supraclavicular lymphadenectomy in Zhenghou University Affiliated Cancer Hospital from 2013 to 2015. The inclusion criteria were female，invasive carcinoma，positive axillary lymph nodes(≥10)，or positive supraclavicular and subclavian lymph nodes，without distant metastasis. A total of 208 cases were enrolled and divided into two groups according to different treatment models，with 104 patients in each group. The radiation dose raised group：the radiation dose of chest wall and internal mammary lymphatic drainage area was 50.4Gy，the radiation dose of supraclavicular and infraclavicular lymphatic drainage area was 61.6Gy，and completed in 28 fractions. The regular radiation dose group：the dose of supraclavicular and supraclavicular，chest wall and endomammary lymphatic drainage area was 50Gy/25 fractions. Kaplan-Meier method was used to calculate disease-free survival(DFS)，overall survival(OS) and local recurrence rate(LRR). ［Results］ The median follow-up time was 59 months(40～78 months). The 3-year recurrence rates of supraclavicular and infraclavicular area were 7.1% and 21.4% in the radiation dose raised group and the regular radiation dose group，respectively（P<0.05）. In N3a patients，the 3-year recurrence rate of supraclavicular and infraclavicular in radiatioin dose raised group and in the regular radiation dose group was 14.5% and 20.0%，respectively（P>0.05）. In N3c patients，the 3-year recurrence rate of supraclavicular and infraclavicular in radiation dose raised group and in the regular radiation dose group was 7.1% and 28.6%，respectively（P<0.05）. The 3-year OS was 79.8% and 69.2%，and the 3-year DFS was 70.1% and 64.4% in two groups respectively（P>0.05）. In N3a patients，the 3-year OS in the radiation dose raised group and the regular radiation dose group was 80.6% and 72.7%；and the 3-year DFS was 61.2% and 67.2%，respectively（P>0.05）. In N3c patients，the 3-year OS of the radiation dose raised group and the regular radiation dose group was 85.7% and 65.3%；the 3-year DFS was 83.3% and 61.2%，respectively(P<0.05）.The incidence of adverse effects in the two groups was not significantly different（P>0.05）. ［Conclusion］ Raised radiation dose in drainage area of supraclavicular and infraclavicular lymph nodes in patients with pT1～3N3M0 after modified radical mastectomy may reduce the recurrence rate of supraclavicular and infraclavicular lymph nodes，and increase the 3-year OS and DFS in N3c patients. |
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