乳腺癌患者术后胸壁复发及预后相关因素分析

目的 乳腺癌出现胸壁复发通常被认为是乳腺癌治疗失败的第一征象,是发生远处转移的先兆.本研究回顾性分析乳腺癌术后胸壁复发患者病例资料,分析影响乳腺癌患者术后胸壁复发及预后的相关因素,为规范的临床治疗提供有用的依据.方法 收集湖南省肿瘤医院2008-01-01-2009 12-31收治的130例乳腺癌术后胸壁复发患者的临床、病理及预后资料,其中Ⅰ期42例,Ⅱ期60例,Ⅲ期28例,分析其临床特点和胸壁复发时间,Kaplan-Meier法计算患者无瘤生存率,采用二元Logistic回归分析复发的影响因素,OR及95％ CI为评价指标,采用Cox回归分析生存期的影响因素,HR及95％CI为评价指标.结果 3、5年无瘤生存率分别为58.4％和33.7％,3、5年总体生存率为91.4％和83.9％,中位发病年龄为45岁,中位复发时间为25个月,中位生存时间为56个月.胸壁复发二元Logistic回归分析显示,肿瘤分期、肿瘤大小及细胞分化程度、雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)和Ki-67表达、淋巴结转移是影响乳腺癌患者术后胸壁复发的相关因素,均P＜o.05. Cox分析显示,肿瘤分期、肿瘤细胞分化程度、肿瘤病理类型及C-erbB-2表达是影响患者5年总体生存率的因素,均P＜0.05.结论 肿瘤分期晚、肿瘤偏大,肿瘤细胞分化程度低、存在4枚及以上腋窝淋巴结转移、ER和PR低表达及Ki-67高表达是乳腺癌术后胸壁复发的危险因素,而临床分期Ⅲ期、肿瘤细胞低分化、肿瘤病理类型为浸润型癌、C-erbB-2阳性表达是总生存的独立预后因素,对存在上述危险因素的患者,应根据患者情况选择个体化的综合治疗方案,加强随访改善患者预后.

Analysis of recurrence and prognostic factors of chest wall recurrence in breast cancer after surgery

OBJECTIVE Chest wall recurrence of breast cancer were generally considered to be the first sign of breast cancer treatment failure and distant metastasis.Retrospective analysis of chest wall recurrence of breast cancer patients after operation was performed to analyze the correlation factors of recurrence and prognosis for the chest wall recur rence in breast cancer patients,in order to provide a useful basis for clinical treatment.METHODS The clinical,pathological and immunohistochemical data of 130 cases with breast cancer including 42 cases in stage Ⅰ,60 cases in stage Ⅱ and 28 cases in stage Ⅲ from January 1,2008 to December 31,2009 in this hospital were analyzed and the clinical fea tures were observed by follow-up.The disease-free survival rates was analyzed by Kaplan-Meier curve method,recurrence risk factor analysis was executed by the binary Logistic regression analysis,the OR and 95 ％CI as the evaluation index,and the overall survive risk factor analysis was executed by Cox regression analysis,HR and 95 ％CI for evaluation index.RESULTS The 3 and 5-year disease-free survival rates of these patients were 58.4％ and 33.7％,respectively.The 3 and 5-year overall survival rates of these patients were 91.4％ and 83.9％,respectively.Median age was 45 years.Median recurrence time was 25 months and median survival time was 56 months.The binary Logistic regression analysis showed that tumor stage,tumor size and differentiation,the expression of ER,PR and Ki-67,and lymph node metastasis were the factors that affected the chest wall recurrence in the breast cancer (P＜0.05).Cox regression analysis showed that tumor stage,tumor differentiation,tumor pathological type,the expression of C-erbB 2 were the factors affected the overall survival rate of 5 years (P＜0.05).CONCLUSIONS The breast cancer patients with late tumor stage,tumor diameter ＞5 cm,low differentiation,lymph node metastasis,ER/PR low expressions and Ki-67 high expression were the risk factors of chest wall recurrence of breast cancer.Clinical stage acuity Ⅲ,poorly differentiated tumor cells,tumor pathology types for infiltrating carcinoma,C-erbB-2 positive expression were independent prognostic factors for overall survival.the patients of danger factors should choose individualized comprehensive treatment plan according to patients condition,strengthen follow-up improving the prognosis.