Clinical-Pathologic Features and Outcomes of Radiation Therapy in a Large Cohort of Patients with Operable Breast Cancer

乳癌病人的臨床病理特徵與放射治療成果

賴俞璇(Yu-Hsuan Lai) ； 陳紘玉(Hung-Yu Chen) ； 詹凱翔(Kai-Hsiang Chan) ； 陳海雯(Helen H. W. Chen)

《放射治療與腫瘤學》 20卷3期 (2013/09) Pp. 159-169

https://doi.org/10.6316/TRO/201320(3)159

摘要

Purpose: To evaluate our relative large institutional experience of the clinical-pathologic features and outcomes of radiation therapy in patients with operable primary breast cancer.Materials and Methods: We reviewed 1,623 consecutive patients with operable breast cancers which received complete course of adjuvant radiation therapy at our institution between 1988 and 2009. All patients underwent either mastectomy or breast conserving surgery (BCS) as part of their treatment. Clinical-pathologic and outcome parameters were analyzed. Kaplan-Meier product limit method was used to estimate loco-regional recurrence-free survival (LRFS), metastasis-free survival (MFS), disease-free survival (DFS) and overall survival (OS). Cox proportional hazards models were performed to assess the prognostic significance of these clinicalpathologic parameters on LRFS.Results: The median follow-up was 6.1 years (range, 2.3 months - 23.0 years). Among these 1623 patients, a total of 83 (5.1%) patients developed loco-regional recurrences, which occurred at 4.7 months to 12.5 years (mean, 2.0 years) after surgery. The 5-year LRFS, MFS, DFS and OS were 95.1%, 83.5%, 79.8%, 85.4% respectively for the entire cohort. Multivariate analyses showed that patients with advanced T stage, nodes positive, HER2 positive or triple negative tumors (ie, ER negative, PR negative and HER2 negative) had poor prognosis on LRFS (all P ＜ 0.05). For 39 patients with initial stage IV breast cancer and receiving post-operation adjuvant radiotherapy, the 5-year loco-regional control rate was 89.9%.Conclusions: Our results are consistent with others that radiation therapy is a very effective adjuvant treatment on loco-regional control in breast cancer patients. Triplenegative and HER2-positive profiles are prognostic markers for loco-regional recurrence. Aggressive local therapy improves local control in metastatic breast cancer.

關鍵字

放射治療 ； 乳癌 ； 臨床治療成果

並列摘要

Purpose: To evaluate our relative large institutional experience of the clinical-pathologic features and outcomes of radiation therapy in patients with operable primary breast cancer.Materials and Methods: We reviewed 1,623 consecutive patients with operable breast cancers which received complete course of adjuvant radiation therapy at our institution between 1988 and 2009. All patients underwent either mastectomy or breast conserving surgery (BCS) as part of their treatment. Clinical-pathologic and outcome parameters were analyzed. Kaplan-Meier product limit method was used to estimate loco-regional recurrence-free survival (LRFS), metastasis-free survival (MFS), disease-free survival (DFS) and overall survival (OS). Cox proportional hazards models were performed to assess the prognostic significance of these clinicalpathologic parameters on LRFS.Results: The median follow-up was 6.1 years (range, 2.3 months - 23.0 years). Among these 1623 patients, a total of 83 (5.1%) patients developed loco-regional recurrences, which occurred at 4.7 months to 12.5 years (mean, 2.0 years) after surgery. The 5-year LRFS, MFS, DFS and OS were 95.1%, 83.5%, 79.8%, 85.4% respectively for the entire cohort. Multivariate analyses showed that patients with advanced T stage, nodes positive, HER2 positive or triple negative tumors (ie, ER negative, PR negative and HER2 negative) had poor prognosis on LRFS (all P ＜ 0.05). For 39 patients with initial stage IV breast cancer and receiving post-operation adjuvant radiotherapy, the 5-year loco-regional control rate was 89.9%.Conclusions: Our results are consistent with others that radiation therapy is a very effective adjuvant treatment on loco-regional control in breast cancer patients. Triplenegative and HER2-positive profiles are prognostic markers for loco-regional recurrence. Aggressive local therapy improves local control in metastatic breast cancer.

並列關鍵字

Radiation therapy ； Breast neoplasms ； Clinical outcome