Locoregional recurrence-associated factors and risk-adapted postmastectomy radiotherapy for breast cancer staged in cTI-2N0-I after neoadjuvant chemotherapy
Locoregional recurrence-associated factors and risk-adapted postmastectomy radiotherapy for breast cancer staged in cTI-2N0-I after neoadjuvant chemotherapy
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新辅助化疗后 cTI-2N0-I 期乳腺癌局部区域复发相关因素和风险适应放疗
DOI：
10.2147/cmar.s173628
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发表时间：
2018-01-01
影响因子：
3.3
通讯作者：
Wang, Ping
中科院分区：
文献类型：
--
作者：
Wang, Xin;Xu, Liming;Wang, Ping
目的：为了确定局部复发（LRR）的相关危险因素，评估乳房切除术后放疗（PMRT）在早期乳腺癌（BC）、新辅助化疗（NAC）和乳房切除术中的作用，回顾性分析临床分期为T1-2N0-1的BC。患者和方法：共纳入217例患者。中位年龄为50岁（24-72岁）。临床分期为cT1 15例，cT2 202例，cN0 53例，cN1 161例。所有患者均行NAC和乳房切除术，128例患者接受PMRT治疗。结果：中位随访61个月，5年累计LRR率为12%。多因素分析显示病理性N分期、淋巴血管浸润和组织学分级是与LRR相关的独立预后因素。基于这些因素建立nomogram模型，在此基础上将患者深度分层为低危组和高危组。低危组放疗未降低LRR （PMRT组为3.3%，无PMRT组为1.7%，P=0.192）。而在高危组，PMRT显著降低LRR （PMRT组为21.8%，无PMRT组为42.2%，P=0.031）。结论：在cT1-2N0-1分期的BC患者中，淋巴血管浸润、组织学分级和病理N分期是影响LRR的重要预后因素，这些患者接受了NAC和乳房切除术。在我们的队列中，在推荐辅助PMRT时，不仅要考虑临床和病理分期信息，还要考虑其他危险因素。在高危亚组中，PMRT显著改善预后。
Objective: In order to identify risk factors associated with locoregional recurrence (LRR) and assess the role of postmastectomy radiotherapy (PMRT) in early breast cancer (BC), managed with neoadjuvant chemotherapy (NAC) and mastectomy, a retrospective analysis of BC diagnosed with clinical stage T1-2N0-1 was conducted.Patients and methods: A total of 217 patients were included in this analysis. The median age was 50 years (24-72 years). The clinical stage distributions were cT1 in 15 cases, cT2 in 202, cN0 in 53, and cN1 in 161 cases. All patients were treated with NAC and mastectomy, and 128 patients received PMRT.Results: With a median follow-up time of 61 months, the 5-year cumulative LRR rate was 12%. Multivariate analysis demonstrated that pathological N stage, lymph-vascular invasion, and histological grade were independent prognostic factors associated with LRR. A nomogram model based on these factors was established, based on which the patients were deeply stratified into low- and high-risk group. In the low-risk group, radiotherapy did not decrease LRR (3.3% in PMRT group, 1.7% in no PMRT group, P=0.192). While in the high-risk group, PMRT significantly decreased LRR (21.8% in PMRT group, 42.2% in no PMRT group, P=0.031).Conclusion: Lymph-vascular invasion, histological grade, as well as pathological N stage were important prognostic factors associated with LRR in BC patients staged in cT1-2N0-1, who were managed with NAC and mastectomy. In our cohort, not only clinical and pathological stage information but also other risk factors were taken into consideration when adjuvant PMRT was recommended. In the high-risk subgroup, PMRT significantly improved the prognosis.