| BackgroundThe breast caneer is seriously a kind of malignant tumor which threatens a large number of women's life health.The breast caneer is not so PoPular in our country,but in recent years,it has an obvious trend of aseension,and the frequency of suffering from it has ranks the first two in female malignant tumor,and it has become a serious disease which threatens female's health and life.With constantly consummating of early diagnosis,early treatment and adjuvant therapy of breast cancer,disease-free survival and totally survival had improved significantly after the therapy of breast cancer,but recurrence and transfer after the therapy is still a major cause of death for breast cancer。Axillary lymph node metastasis positive after the therapy of breast cancer＞4 of the use of radiotherapy in patients with a broad consensus has been achieved,but the number of positive transfer of 1～3,the need for radiotherapy still controversial.ObjectiveTo evaluate the effect of guiding significance in breast cancer of axillary lymph node metastasis after a positive number one to three of the lymph node metastasis rate of postoperative radiotherapy,So as to provide reasonable treatment after breast cancer postoperative.Material and MethodsBetween January 1995 to December 2002 during the hospital treated breast cancer,axillary lymph node metastasis 1～3 and T1～T3N1M0 stage(TNM stage, UICC1997 standards) patients as research object.Surgery using radical operation, modified radical mastectomy and expand radical operation.All patients for postoperative chemotherapy.For metastatic lymph nodes in patients with 1 to 3,in accordance with lymph node metastasis rate≥30%and lymph node metastasis rate＜30%were divided into two groups.Were collected in the two groups of patients receiving radiotherapy with radiotherapy in patients with relevant information. Follow-up of 5 to 10 years.Follow-up collection target age,menstrual and other basic conditions,as well as tumor stage,the positive rate of lymph node metastasis, radiation therapy and other treatment-related cases,and survival time and treatment outcome of the situation and compared.Use SAS9.13 statistical analysis software for data analysis.Comparison of the rate of use ofχ2 test;survival factors using Cox regression model multi-factor analysis.Results1.Follow-up caseChoose 298 cases from 1995 to 2002 in our hospital 965 cases of breast cancer patients with axillary lymph node dissection in the detection and the number of＜10,the number of positive lymph node 1 to 3,according to lymph node metastasis rate of＞30%(no radiotherapy and radiotherapy),＜30%(no radiotherapy and radiotherapy) for a division.2.General informationAll patients were women,aged 29 to 76 years old,with an average age of 44.5. Age distribution:593 cases of＜50-year-old,372 cases of≥50 years;Menstruation: 423 cases of postmenopausal women,and 542 cases of unmenopause.3.Treatment-related informationIn 965 cases of patients,use of radical surgery of 338 cases,618 cases use modified radical mastectomy,of 9 cases use radical expansion.965 cases were performed in patients with axillary lymph node dissection,and postoperative pathology confirmed no residual tumor margin.All patients for postoperative chemotherapy.Choice of radiotherapy using randomized manner,213 patients of lymph node metastasis 1～3,lymph node metastasis rate of＞30%,has 107 patients received the radiotherapy;85 patients of lymph node metastasis rate＜30%,has 40 patients received the radiotherapy.4.The patients with number of positive metastasis axillary lymph nodes is 1～3 recurrence and survival rates situations298 cases of patients in this group,3-year and 5-year overall survival rates were 86.9%and 75.2%.Its five-year recurrence rate of chest wall with positive lymph node metastasis rate increase also increased year by year.5.Single factor analysis resultsSingle factor analysis results suggest that the age,menstruation,lymph node metastasis rate and whether radiotherapy there are statistically significant(P＜0.05).6.The prognosis of local recurrenceLymph node metastasis to the chest wall recurrence rate as a prognostic factors, it was found that from 30%positive rate of transfer have statistical significance(P＜0.05).7.The influence of radiotherapy and lymph nodes rate in patients with 1～3 positive metastasis axillary lymph nodes7.1 The influence of radiotherapy in the lymph nodes rate≥30%After detecting lymph nodes rate in patients with≥30%of the patients,the patients receiving radiotherapy and radiotherapy patients did not receive their local recurrence rate,compared to the rate of distant metastasis,and the differences have statistically significant(P＜0.05).7.2 The influence of radiotherapy in the lymph nodes rate＜30%After detecting lymph nodes rate in patients with＜30%of the patients,the patients receiving radiotherapy and radiotherapy patients did not receive their local recurrence rate of distant metastasis rate,the difference was not statistically significant(P＞0.05).8.The multivariate analysis based on COX modelMultivariate analysis results suggest that menstrual cases,tumor stage,lymph node metastasis rate and whether radiotherapy with breast cancer have an impact on the on the survival of patients situation,with statistical significance(P＜0.05).ConclusionsIf the number of positive axillary lymph node detected is less than 10 for the breast cancer patients,combined with the ratio of positive metastasis axillary lymph nodes＜30%,it isn't advised to take postoperative radiotherapy and prognosis.If the number of positive axillary lymph node detected is less than 10 for the breast cancer patients,combined with the ratio of positive metastasis axillary lymph nodes≥30%,it is advised to take more accurately criteria postoperative radiotherapy and prognosis. |
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