| Purpose:The incidence rate of breast cancer is the highest in women.The comprehensive treatment of breast cancer plays an important role in breast cancer.NCCN guidelines suggest that for patients with more than 4 positive axillary lymph nodes(ALN),RT to chest wall + infraclavicular region,supraclavicular area,internal mammary lymph nodes(INLN),and any part of the axillary bed at risk;Strongly consider RT to chest wall + infraclavicular region,supraclavicular area,INLN,and any part of the axillary bed at risk for patients with 1-3 positive ALN;Consider RT to chest wall ±infraclavicular region,± supraclavicular area,± INLN and any part of the axillary bed at risk for patients with Negative axillary nodes and tumor >5 cm.However,the positive effect of internal mammary lymph nodes irradiation(IMLNI)on survival and prognosis is still controversial.At present,there are few studies on the survival and prognosis of breast cancer after radical mastectomy.The purpose of this study was to compare the clinical data of 124 patients with/without IMLNI,to make a preliminary exploration on the efficacy,related adverse effects and related prognostic factors of IMLNI in the treatment of breast cancer with positive axillay lymph nodes.Materials and methods:Retrospective analysis of 124 patients with positive ALN stage II-III breast cancer who underwent modified radical mastectomy in our hospital from 2010 to2015.All patients had received systemic chemotherapy and/or endocrine therapy.propensity score matching(PSM)was used to balance the covariances between the two groups.Matching was performed by the minimal adjacent method of 1∶2 pairing.87 patients were enrolled.According to whether receive IMLNI was divided into IMLNI group(33 cases),non-IMLNI group(54 cases).Calculate and analyze the5-year overall survival(OS),cancer specific survival(CSS),disease-free survival(DFS),local recurrence rate(LRR),and distant metastasis rate(DM)of patients.Univariate and multivariate analysis were used to analyze the factors affecting prognosis and to find subgroups with poor prognosis.Calculate the status of late side reactions caused by radiotherapy.Kaplan Meier method was used to draw survival curve.Log rank method and Cox proportional hazard regression model were used for univariate survival analysis and multivariate survival analysis.P<0.05 was considered statistically significant.Result:(1)The median follow-up time was 79.0(8.3-137.2)months.After 5 years of follow-up,12 patients died,8 patients had local recurrence,and 17 patients had distant metastases.The 5-year OS、CSS、DFS、LRR、DM of the whole group were86.2%、86.2%、75.9%、9.2%、19.5%,respectively.(2)The 5-year OS of patients with or without IMLNI was 87.9% and85.2%,respectively(P>0.05).The 5-year DFS was 78.8% and 74.1%,respectively(P>0.05).The 5-year LRR was 6.1% and 11.1%,respectively(P>0.05).The 5-year DM was 18.2% and 20.4%,respectively(P>0.05).(3)Univariate analysis showed that the ER and PR had a statistically significant difference in 5-year OS、DFS、DM(P<0.05).Endocrine therapy can significantly improve 5-year OS in ER and/or PR positive patients.The other factors had no significant difference in the OS,DFS,LRR and DM(P>0 05).(4)Multivariate analysis showed the ER and PR had a statistically significant difference in 5-year OS、DFS、DM(P<0.05).The other factors had no significant difference in the OS,DFS,LRR and DM(P>0 05).Conclusion:(1)The selection of patients with IMLNI must strictly follow the indications,and still needs to be supported by more large-scale clinical trials.(2)This study failed to find out the benefit of IMLNI in 5-year Prognosis,and further analysis are expected after expanding the sample size and extending the follow-up time.(3)It is necessary to balance the possible survival benefits of IMLNI with radiotherapy related side effects.And the risk of myocardial injury and lung injury can be reduced by improving radiotherapy technology.(4)Endocrine therapy can significantly improve 5-year OS in ER and/or PR positive patients. |
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