乳腺癌术后放疗对分子亚型与预后关系影响分析

目的 回顾分析术后放疗对乳腺癌分子亚型与生存关系的影响。方法 对2008年收治的716例首次行单侧乳腺癌手术女性患者,按2011 St. Gallen标准分为Luminal A型(LA)、B-HER-2阴性型(LB1)、Luminal B-HER-2阳性型(LB2)、HER-2过表达型(HER-2⁺)、三阴型(TN)和未分型组。采用Cox模型分析总体、非放疗、放疗组中亚型间OS和DFS差异。Kaplan-Meier法计算OS、DFS,Cox模型因素分析。结果 中位随访71.4个月,总死亡率为10.5%、治疗失败(死亡+复发+转移)率为14.9%。术后放疗组217例(30.3%)。多因素分析OS在各组中亚型间差异均无统计学意义(P均>0.05);DFS在总体中LB1、未分型较LA型的差(HR=1.881、1.907,P=0.035、0.049),在非放疗组中LB1较LA型的差(HR=3.324,P=0.01);在放疗组中各亚型的均相近(P均>0.05)。放疗和亚型二维交叉分析表明非放疗组LB1与放疗组LA比较有降低OS (P=0.09)和DFS (P=0.06)趋势。结论 与LA型相比,LB1型有降低OS、DFS趋势,以非放疗患者明显;放疗对分子亚型和生存预后关系无影响。

Impact of postoperative radiotherapy on the relationship between molecular subtype and prognosis in patients with breast cancer

Objective To retrospectively investigate the impact of postoperative radiotherapy (RT)on the relationship between molecular subtype and survival in patients with breast cancer (BC). MethodsA total of 716 women who were admitted to our hospital in 2008 and newly received unilateral mastectomy were divided into Luminal A (LA), Luminal B-HER-2^-negative (LB1), Luminal B-HER-2^-positive (LB2), HER-2 overexpression (HER-2⁺), triple-negative (TN), and unassigned subtypes according to the 2011 St. Gallen Consensus. The Cox model was used to analyze the differences in overall survival (OS) and disease-free survival (DFS) rates between subtypes in all patients, RT group, or non-RT group. The Kaplan-Meier method was used to calculate OS and DFS rates. The Cox model was used to perform the factor analysis. Results In all patients, the median follow-up time was 71.4 months;the overall mortality rate was 10.5%;the incidence of treatment failure (death+relapse+metastasis) was 14.9%;217 patients (30.3%) received RT. The multivariate analysis showed that there was no significant difference in OS between subtypes in any group (all P>0.05). In all patients, patients with LB1 subtype or unassigned subtype had significantly poorer DFS rates than those with LA subtype (HR=1.881, P=0.035;HR=1.907, P=0.049). In the non-RT group, patients with LB1 subtype had significantly poorer DFS rates than those with LA subtype (HR=3.324, P=0.01). In the RT group, there was no significant difference in DFS rate between subtypes (all P>0.05). The two-dimensional cross analyses of RT and subtype demonstrated that patients with LB1 subtype in the non-RT group had lower OS and DFS rates than patients with LA subtype in the RT group (P=0.09,0.06). Conclusions Patients with LB1 subtype have lower OS and DFS rates than patients with LA subtype, especially in the non-RT patients. RT has no impact on the relationship between subtype and prognosis.