乳腺癌保乳术后1~3个腋窝淋巴结阳性者锁骨上淋巴结复发风险分析

目的 分析乳腺癌保乳术后1~3个腋窝淋巴结阳性患者锁骨上淋巴结复发率(SCFR)及高危因素。方法 回顾分析2001—2014年本院收治的保乳术+腋窝淋巴结清扫术后乳腺癌患者,病理证实1~3个腋窝淋巴结阳性,无内乳和锁骨上淋巴结转移或远处转移。256例均行全乳腺放疗,剂量46~50 Gy (2 Gy/次)或43.5 Gy (2.9 Gy/次),瘤床总剂量50~70 Gy。245例接受了辅助化疗,45例Her-2受体阳性者18例接受曲妥珠单抗治疗。Kaplan-Meier法计算同侧SCFR、LRR、DM及OS,并Logrank法检验。结果 随访时间满5年的样本量为101例。全组5年SCFR、LRR、DM、OS分别为2.1%、2.1%、5.0%、98.0%,2~3个腋窝淋巴结阳性(P= 0.010)、脉管瘤栓(P= 0.030)、LuminalB型(P= 0.006)为锁骨上淋巴结复发的高危因素。腋窝淋巴结阳性数为2~3个和1个者的5年SCFR分别为5.3%和2.8%(P=0.010);脉管瘤栓阳性和阴性的5年SCFR分别为5.3%和1.8%(P=0.030);Luminal B型、三阴性、Luminal A型和Her-2阳性型的5年SCFR分别为7.1%、3.2%、1.2%和0%(P=0.006)。有0、1、2~3个高危因素患者的5年SCFR分别为0%、3.0%、10.6%(P=0.000)。结论 在接受现代化疗前提下,乳腺癌保乳术后1~3个腋窝淋巴结阳性者SCFR较低,不需要全部行锁骨上区预防照射。有高危因素患者是否行预防性锁骨上区照射需进一步研究。

Risk factors for supraclavicular nodal failure in breast cancer patients with one to three positive axillary nodes treated with breast conserving surgery

Objective To evaluate the supraclavicular nodal failure (SCF) of the breast cancer patients with one to three positive axillary nodes treated with breast conserving surgery and to identify the risk factors for SCF. Methods From Jan. 2001 to Mar. 2014, 256 breast cancer patients with one to three positive axillary nodes treated with breast conserving surgery and axillary dissection were analyzed. All patients received whole breast radiation to a total dose of 46－50 Gy (median 50 Gy) at 2 Gy/f or 43.5 Gy at 2.9 Gy/f. Tumor bed was boosted to 50－70 Gy (median 60 Gy) at 2 Gy/f or 52.2 Gy at 2.9 Gy/f. No patient received regional nodal radiation. 245(95.7%) patients received adjuvant chemotherapy. The SCF, LRR, DM and OS rates were calculated by Kaplan-Meier method and compare by the Logrank test. Results The number of samples were 101 followed up at 5 years. The 5-year SCF, LRR, DM and OS rates were 2.1%, 2.1%, 5%, 98%, respectively. LVI and 2 to 3 positive axillary node and Luminal B were risk factors for SCF (P=0.030,0.010,0.006). The 5-year SCF rate were 5.3% for patients with 2－3 positive axillary nodes and 2.8% for those with 1 positive nodes (P=0.010);5.3% and 1.8% for those LVI positive and negative (P=0.030);7.1%, 3.2%, 1.2% and 0% for Luminal B, Basal, Luminal A and Her-2 positive type (P=0.006). Patients with 0, 1 and2-3 risk factors had 5 year SCF rates of 0%, 3.0% and 10.6%(P=0.000). Conclusions The supraclavicular nodal recurrence rate is very low for breast cancer patients with one to three positive axillary nodes treated with breast conserving surgery without supraclavicular nodal radiation, indicating that prophylactive supraclavicular nodal is not necessary. Further research is needed to verify whether those patients with risk factors need SCF radiation or not.