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目的新辅助化疗(neoadjuvant chemotherapy,NCT)后未获得病理完全缓解(pathological complete response,pCR)的局部晚期乳腺癌(locally advanced breast cancer,LABC)患者的治疗影响乳腺癌整体预后的提高。本研究评估不同的根治手术对NCT后未获得pCR的Ⅲ期LABC患者的预后影响。方法收集天津医科大学肿瘤医院2011-01-01-2013-12-31收治的186例NCT后未获得pCR的Ⅲ期LABC患者的临床资料,其中120例行改良根治术(modified radical mastectomy,MRM),66例行Halsted根治术(HRM),分析不同的根治手术对3年无局部区域复发生存率(loco-regional recurrence-free survival,LRRFS)和无远处转移生存率(distant metastasis-free survival,DMFS)的影响。结果 Kaplan-Meier分析显示,MRM组和HRM组3年LRRFS分别为86.8%和93.8%,差异无统计学意义,χ~2=2.296,P=0.130;3年DMFS分别为80.0%和87.9%,差异无统计学意义,χ~2=0.774,P=0.379。但对于ⅢB/ⅢC期患者MRM组和HRM组的3年LRRFS分别为80.5%和95.2%,差异有统计学意义,χ~2=4.792,P=0.029;3年DMFS分别为76.2%和85.7%,差异无统计学意义,χ~2=0.298,P=0.585。N3期患者而不是T>5cm患者可以得到相似的结果。单因素分析结果显示,绝经状态(χ~2=4.317,P=0.038),肿瘤大小(χ~2=4.200,P=0.040),淋巴结分期(χ~2=4.635,P=0.031)也与ⅢB/ⅢC期局部晚期乳腺癌患者的3年LRRFS相关。Cox回归分析显示,术式(HR=0.211,P=0.047),淋巴结分期(HR=4.725,P=0.020)为影响ⅢB/ⅢC期局部晚期乳腺癌患者LRRFS的独立预后因子。结论 HRM可以提高ⅢB/ⅢC期局部晚期乳腺癌患者3年LRRFS,降低患者的局部区域复发率,改善局部晚期乳腺癌患者预后。
Objective To investigate the effect of treatment of locally advanced breast cancer (LABC) patients without pathological complete response (pCR) after neoadjuvant chemotherapy (NCT) on the overall prognosis of breast cancer. This study evaluated the prognostic impact of various radical procedures on stage III-LABC patients who did not receive pCR after NCT. Methods Totally 186 patients with stage Ⅲ LABC who did not receive pCR after NCT were enrolled in the Tumor Hospital of Tianjin Medical University from January 2011 to January 2013. Totally 120 patients underwent radical radical mastectomy (MRM) , 66 patients underwent Halsted radical mastectomy (HRM), and analyzed the effect of different radical operations on 3-year local recurrence-free survival (LRRFS) and distant metastasis-free survival DMFS). Results The Kaplan-Meier analysis showed that the 3-year LRRFS of MRM group and HRM group were 86.8% and 93.8% respectively, with no significant difference (χ ~ 2 = 2.296, P = 0.130). The 3-year DMFS were 80.0% and 87.9% The difference was not statistically significant, χ ~ 2 = 0.774, P = 0.379. However, the 3-year LRRFS of patients with stage ⅢB / ⅢC were 80.5% and 95.2% respectively, with statistical significance (χ ~ 2 = 4.792, P = 0.029). The 3-year DMFS were 76.2% and 85.7% , The difference was not statistically significant, χ ~ 2 = 0.298, P = 0.585. Patients in stage N3, but not in patients with T> 5 cm, could achieve similar results. The results of univariate analysis showed that in menopausal status (χ ~ 2 = 4.317, P = 0.038), tumor size (χ ~ 2 = 4.200, P = 0.040) 3-year LRRFS of patients with locally advanced stage Ⅲ / ⅢC breast cancer. Cox regression analysis showed that surgical procedures (HR = 0.211, P = 0.047) and lymph node staging (HR = 4.725, P = 0.020) were independent predictors of LRRFS in stage ⅢB / ⅢC patients with locally advanced breast cancer. Conclusion HRM can improve 3-year LRRFS in stage ⅢB / ⅢC patients with locally advanced breast cancer, reduce the local recurrence rate and improve the prognosis of patients with locally advanced breast cancer.