| Objective: To research the prognostic factors affecting the 191 cases of early breast cancer patients with conserving surgery and discuss the influence on treatment efficacy with different sequence of radiation and chemotherapy.Methods: We have analyzed 191 cases of early breast cancer after breast conservation surgery who were treated in the Second Hospital Of DaLian Medical University,from January 1st,2006 to December 31 st,2015.Among 191 patients,32 patients were in radiotherapy first group,107 patients were in chemotherapy first group,52 patients were in sandwich group.All of the patients were reserved for 1y,3y,5y LRR and OS.And the factors were analyzed independently which associated with the 5y OS of the patients,from the patients' age,menopausal status,pathology type,tumor size,axillary lymph node,Molecular typing of breast cance,the interval between surgery and radiation,vascular tumor emboli.Multiple factors analysis is based on the Single factor analysis to find the risk factors of early stage breast cancer patients with conserving surgery.Comparing the 5y LRR and OS of radiotherapy first group,chemotherapy first group and sandwich group.Then research the different sequence of radiation and chemotherapy impacting on prognosis.Comparing the 5y LRR and 5y OS of radiotherapy first group,chemotherapy first group,the sandwich group in patients with high risk factors and analyze the factors associated with the prognosis of patients.Results: The last follow-up was October 31,2016,median follow-up was 58 months(8-122 months).There were 6 patients lost in the follow-up,follow-up rate was 97.8%.For all the patients,1y,3y,5y LRR were 0.5%?3.0%?8.9% respectively,1y,3y,5y OS were 99.4%,96.9%,87.7% respectively.Single factor analysis results suggested that age?tumor size?axillary lymph node?vascular tumor emboli?the interval between surgery and radiation?Molecular typing were the factors associated with 5y OS(P< 0.05).There was no significance difference associated with 5y OS in menopausal status?pathological type(P> 0.05).Multiple factor analysis showed that tumor size?axillary lymph node?vascular tumor emboli?the interval between surgery and radiation were independent risk factors associated with 5y OS(P< 0.05).There was no significance difference associated with 5y OS in age?Molecular typing of breast cance(P> 0.05).For patients in radiotherapy first group,chemotherapy first group and sandwich group 5y LRR were 7.1%,11.2%,7.2% respectively,5y OS were 84.6%,91.7%,95.3% respectively,without statistical difference(P> 0.05).Patients with T1?T2 stage 5y LRR were 4.5% and 11.9%,5y OS were 94.6% and 78.0%,with statistical difference(P< 0.05).Patients with T1 stage in radiotherapy first group,chemotherapy first group,sandwich group 5y LRR were 5.3%,3.8%,4.3% respectively,5y OS were 87.4%,89.8%,92.5% respectively,without statistical difference(P> 0.05).Patients with T1 stage in each groups 5y LRR were 14.7%,11.6%,3.5% respectively,5y OS were 82.3%,71.1%,93.6% respectively,without statistical difference(P>0.05).Patients with lymph node N0 and N1 stage 5y LRR were 8.6% and 9.8%,5y OS was 90.9% and 83.6%,with statistical difference(P<0.05).For patients with N0 stage in radiotherapy first group,chemotherapy first group,sandwich group 5y LRR were 11.2%,7.3%,5.8% respectively,5y OS were 92.3%,88.5%,96.7% respectively,without statistical difference(P>0.05),For patients with N1 stage patients in chemotherapy first group and the sandwich group 5y LRR were 4.5% and 16.2%,with statistical difference(P<0.05).5y OS were 81.3% and 85.6%,without statistical difference(P>0.05).Patients with vascular tumor emboli or without vascular tumor emboli 5y LRR were 13.1% and 6.4%,5y OS were 79.4% and 91.6%,with statistical difference(P<0.05).People with vascular tumor emboli in radiotherapy first group,chemotherapy first group,the sandwich group 5y LRR were 5.3%,9.2%,18.1% respectively,5y OS were 61.5%,90.1%,87.2% respectively,with statistical difference(P<0.05).For people without vascular tumor emboli,there was no statistical difference in 5y LRR and 5y OS between radiotherapy first group,chemotherapy first group and the sandwich group(P>0.05).The time interval Surgery and radiation(?6m vs >6m)5y LRR were 4.4% and 14.1%,5y OS were 90.5% and 85.7%,with statistically significant(P< 0.05).For patients started radiation within 6m after surgery in radiotherapy first group,chemotherapy first group,the sandwich group 5y LRR were 3.1%,8.2%,17.5% respectively,5y OS were 83.9%,90.5%,88.6% respectively,without statistical difference(P > 0.05).However,patient in chemotherapy first group the time interval surgery and radiation(?6m vs >6m)5y LRR was 5.2% and 14.1%,5y OS were 96.9% and 85.7%,with statistical difference(P<0.05).Conclusion: 1.Tumor size,axillary lymph node,vascular tumor emboli,the time interval surgery and radiation are the independent factors associated with 5y OS of early stage breast cancer patients with conservation surgery.2.For early stage breast cancer patients under conservation surgery with node positive,chemotherapy first group,was premier than sandwich group in 5y LRR.However,there was no statistical significance difference in 5y OS.3.For early stage breast cancer patients with vascular tumor emboli,sandwich group will increase the risk of LRR than others.Besides,radiotherapy first will affected the OS.The chemotherapy should be taken first for patients with vascular tumor emboli.4.For early stage breast cancer patients with conservation surgery,There is no difference in LRR and OS when started radiation within 6m after surgery.For patients in chemotherapy first group,radiotherapy should be start within 6m after surgery.Otherwise,delaying in radiation therapy will increase the risk of LRR and affected the OS. |
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