摘要目的 探讨乳腺癌保乳术后辅助放疗和化疗顺序对患者预后的影响.方法 回顾性分析1 154例T1~2N0~3单侧乳腺癌患者保乳术后行放疗和化疗的临床资料,其中先放疗后化疗组(先放疗组)603例,先化疗后放疗组(先化疗组)551例.采用Kaplan-Meier法和Log rank检验分析患者的临床病理特征和治疗对生存率的影响.结果 全组患者的5年无病生存率和总生存率分别为93.0%和97.8%.先放疗组和先化疗组患者的5年总生存率分别为98.6%和96.4%,差异无统计学意义(P=0.191).先放疗组和先化疗组患者的5年无病生存率分别为92.7%和93.2%,差异无统计学意义(P=0.430).先放疗组和先化疗组Luminal A型患者的5年总生存率分别为99.6%和97.8%,差异无统计学意义(P=0.789);先放疗组和先化疗组Luminal B型患者的5年总生存率分别为94.2%和96.0%,差异无统计学意义(P=0.680);先放疗组和先化疗组三阴性乳腺癌患者的5年总生存率分别为100%和90.9%,差异有统计学意义(P=0.019).先放疗组和先化疗组HER-2阳性患者的5年无病生存率分别为80.1%和100%,差异无统计学意义(P=0.045).结论 乳腺癌保乳术后先放疗与先化疗比较,患者的总生存率和无病生存率无明显差异.先化疗组HER-2阳性患者的5年无病生存率优于先放疗组,先放疗组三阴性乳腺癌患者的5年总生存率优于先化疗组.不同分子分型乳腺癌保乳术后患者的放化疗顺序需进一步研究证实.

abstractsObjective To evaluate the prognostic value of sequencing of adjuvant radiotherapy and chemotherapy following breast-conserving surgery for patients with breast cancer.Methods A total of 1 154 patients withT1-2N0-3M0 breast cancer retrospectively reviewed.All patients received sequential radiotherapy and chemotherapy following breast-conserving surgery.Among them, 603 patients received radiotherapy first and 551 patients received chemotherapy first.Log-rank tests were used to determine significance of disease-free survival (DFS) and overall survival (OS) rates in the Kaplan-Meier curve.Results The 5-year DFS and OS rates for all patients were 93.0% and 97.8%.The 5-year OS rate was 98.6% in the radiotherapy first group and 96.4% in the chemotherapy first group (P=0.191), and the corresponding DFS rate was 92.7% and 93.2% (P=0.430), respectively.Among the patients with Luminal A subtype, the 5-year OS rate was 99.6% in the radiotherapy first group and 97.8% in the chemotherapy first group (P=0.789).Among the patients with Luminal B subtype, the 5-year OS rate was 94.2% and 96.0%, respectively (P=0.680).Among the patients with triple negative breast cancer, the 5-year OS rate was 100% and 90.9%, respectively, with statistically significant differences (P=0.019).Among the patients with HER-2 positive breast cancer, The 5-year DFS rate was 80.1% and 100%, respectively (P=0.045).Conclusions The OS and DFS rates in the chemotherapy first group are not significantly different from those of radiotherapy first group after breast-conserving surgery.Patients with HER-2 positive breast cancer in chemotherapy first group have a much higher DFS rate than that of radiotherapy first group, whereas patients with triple negative breast cancer in radiotherapy first group have a better OS rate than that of chemotherapy first group.Further research is warranted to investigate the benefit of different molecular types in different sequencing of radiotherapy and chemotherapy after breast-conserving surgery.