摘要目的 探讨巩固放疗对根治术后局部区域复发接受R0切除手术的乳腺癌患者预后的影响.方法 回顾性分析2003年1月1日至2015年11月30日期间解放军307医院收治的110例仅局部区域复发后接受R0(切缘阴性)切除手术患者的临床资料,分析其预后因素.结果 74例(67.3％)接受巩固放疗的患者,其中位至局部区域进展时间优于未接受放疗的36例(32.7％)患者,差异有统计学意义(χ2=8.526,P<0.05);接受巩固放疗患者的局部复发后至无远处转移生存期、局部区域复发后总生存期与未接受放疗的患者差异无统计学意义(P>0.05).多因素分析结果显示内分泌治疗(χ2=7.541,95％CI:27.1％ ～80.4％,P<0.05)、无病生存期(≥2年vs.<2年,χ2=4.068,95％CI:101.4％ ～267％,P<0.05)、 巩固放疗(χ2=14.126,95％CI:21.7％ ～80.4％,P<0.05)是局部区域复发R0术后患者局部复发后总生存期的独立预后因素.局部区域复发R0切除术后,同侧胸壁及锁骨上下淋巴引流区巩固照射组复发率低于未照射组.结论 局部区域复发乳腺癌患者R0切除术后需接受同侧锁骨上下区及胸壁巩固放疗.

abstractsObjective To explore the effect of prognosis of consolidation radiotherapy for patients after R0 resection of local recurrence after radical mastectomy. Methods Totally 110 breast cancer patients with local recurrence receiving R0 resection were admitted and treated in our hospital from January 1st, 2003 to November 30th, 2015 were retrospectively analyzed. Results The median local progression time of 74 patients receiving consolidation radiotherapy ( 67.3％) was remarkably better than that of those without radiotherapy(36 patients, 32.7％), and the difference was statistically significant (χ2 =8. 526, P<0.05). Meanwhile, there was no statistically significant difference (P>0.05) of distance disease-free survival and overall survival between the radiotherapy group and the non-radiotherapy group. Multifactor analysis indicated that pseudo-adjuvant endocrine therapy (χ2 =7.541,95％CI:27.1％ -80.4％, P <0.05), DDFS(≥2 years vs. <2 years,χ2 =4.068,95％CI:101.4％ -267％,P<0. 05) and pseudo-adjuvant radiotherapy(χ2 =14.126, 95％CI:21.7％ -80.4％, P <0. 05 ) were the independent risk factors affecting the OS of patients with local recurrence after R0 resection. Conclusions For the patients with local recurrence after R0 resection of local recurrence, it is recommended that consolidation radiotherapy should be done and the radiation field should include the same side of the chest wall and clavicle area lymphatic drainage area.