摘要
目的 根据ER、PR和Her-2的免疫组化检查结果,把改良根治术后的高危乳腺癌患者分为不同亚组,了解放疗对不同亚组患者的作用.方法 回顾分析437例改良根治术后病理为浸润癌的乳腺癌患者资料,分期为T3-4N1或N2-3期,有ER、PR和Her-2的免疫组化检查结果.408例接受了化疗,352例接受了放疗.ER＋或（和）PR＋定义为受体阳性（Rec＋）,ER-和PR-定义和受体阴性（Rec-）,Her-2＋＋或＋＋＋定义为Her-2阳性（Her-2＋）.根据结果分为Rec-/Her-2-（69例）、Rec-/Her-2＋（62例）、Rec＋/Her-2＋（89例）和Rec＋/Her-2-（217例）组,分别分析4个组在放疗和未放疗下局部区域复发率（LRR）、远处转移率（DM）、无瘤生存率（DFS）和总生存率（OS）的差别.复发率和生存率计算用Kaplan-Meier法,差异检验用Logrank法.结果 中位随访48个月,除外5例放疗不详的患者,资料齐全可分析患者432例.放疗降低了4个组患者的5年LRR,Rec-/Her-2-、Rec-/Her-2＋、Rec＋/Her-2＋和Rec＋/Her-2-组放疗和未放疗的5年LRR分别为13.1%和33.3%、9.3%和21.2%、9.7%和47.0%、3.2%和15.4%;对Rec-/Her-2-、Rec-/Her-2＋和Rec＋/Her-2＋患者,放疗降低了5年DM,放疗和未放疗患者的5年DM分别为26.7%和49.2%、27.6%和67.5%、18.4%和100%,并提高5年DFS和OS,三组患者放疗和未放疗的5年DFS分别为66.7%和33.3%、67.7%和33.3%、72.6%和0%,三组患者放疗和未放疗的5年OS分别为73.9%和25.2%、69.8%和41.5%、91.0%和32.8%.结论 不同ER、PR、Her-2状态的改良根治术后高危乳腺癌患者均能从术后放疗中获益.
Objective To evaluate the role of postmastectomy radiotherapy in four subgroups of high-risk breast cancer patients, who were grouped by the status of estrogen receptor （ER）, progesterone receptor （PR） and human epidermal growth factor 2 （Her-2）. Methods A total of 437 invasive breast cancer patients with T3-4N1 or N2-3 and available immunohistochemistry results of ER, PR and Her-2 were retrospectively analyzed. Patients were classified into 4 subgroups according to hormone receptors （ER or PR, Rec） and Her-2 status：Rec-/Her-2-（triple negative）, Rec-/Her-2 ＋, Rec ＋/Her-2 ＋ and Rec ＋/Her-2-. Rec-was defined as ER-and PR-. Rec ＋ was defined as ER ＋ and/or PR ＋. Her-2 positive was defined as Her-2 ＋ ＋ or Her-2 ＋ ＋ ＋. End points were isolated locoregional recurrence （LRR）, distant metastasis （DM）, disease-free survival （DFS） and overall survival （OS）. Results The median follow up time was 48 months. Sixty-nine （15. 8%） patients were Rec-/Her-2-, 62 （14. 2%） Rec-/Her-2 ＋, 89 （20.4%） Rec ＋/Her-2 ＋ and 217 （49.7%） Rec ＋/Her-2-. 480（93.4%） patients received chemotherapy and 352（80. 5%） received radiotherapy. Radiotherapy significantly reduced the 5-year LRR rates of all the four subgroups （Rec-/Her-2-： 13.1% vs. 33. 3%, Rec-/Her-2 ＋ ：9. 3% vs. 21.2%, Rec ＋ /Her-2 ＋ ：9. 7% vs. 47.0%, Rec ＋/Her-2-：3. 2% vs. 15.4%）. Radiotherapy significantly lowered the 5-year DM rates （26. 7% vs. 49.4%, 27.6% vs. 67. 5%, 18.4% vs. 100%） and improved the 5-year DFS rate （66. 7% vs. 33. 3% , 67.7% vs. 33. 3% , 72. 6% vs. 0%） as well as OS （73.9% vs. 25.2% ,69. 8% vs.41.5%, 91.0% vs. 32. 8%） of patients with Rec-/Her-2-, Rec-/Her-2 ＋ and Rec ＋/Her-2 ＋. Conclusions In high-risk breast cancer patients, all subgroups of patients grouped by ER, PR and Her-2 status can benefit from postmastectomy radiotherapy.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2010年第4期307-310,共4页
Chinese Journal of Radiation Oncology
基金
基金项目：国家“十一五”攻关课题资助项目（2006BA102A10）
关键词
乳腺肿瘤/放射疗法
放射疗法
术后
孕激素受体
雌激素受体
预后
Breast neoplasms/radiotherapy
Radiotherapy, postoperation
Progesterone receptor
Estrogen receptor
Prognosis
