乳腺癌根治术后局部复发的危险因素探讨

目的探讨乳腺癌根治术后局部复发的危险因素。方法回顾性分析1994年1月~2005年6月期间行根治性手术的360例乳腺癌患者的临床资料。结果360例患者中,术后局部复发45例,局部复发率为12.5%(45/360),其中3年内复发38例,占84.4%(38/45)。单因素分析显示:原发灶为T3~4者的局部复发率比T1~2者显著增高(P<0.01),淋巴结转移数目≥4枚者比≤3枚者显著增高(P<0.01),TNM分期为Ⅲ期者比0~Ⅱ者显著增高(P<0.05),未完成辅助放化疗者比完成放化疗者显著增高(P<0.01),而在不同的年龄组、病理类型和手术方式之间的比较无显著差别(P>0.05)。多因素Logistic回归分析显示:淋巴结转移数目与术后局部复发呈正相关(B为1.061,Sig为0.004),转移数目越多局部复发率越高;是否完成辅助放化疗与术后局部复发呈负相关(B为-0.756,Sig为0.036),未完成辅助放化疗者局部复发率高。结论乳腺癌根治术后局部复发与原发灶大小、腋窝淋巴结转移数目、TNM分期和是否完成辅助放化疗有密切关系。其高危因素是淋巴结转移数目≥4枚和术后未完成辅助放化疗。早期发现、早期诊断、早期治疗,术后予辅助放化疗,可降低乳腺癌根治术后的局部复发率。

Risk Factors of Local Recurrence after Radical Operation for Breast Cancer

Objective To explore the risk factors of local recurrence after radical operation for breast cancer.Methods The clinical data of 360 patients with breast cancer who undertook radical operation from January 1994 to June 2005 were analysed retrospectively.Results 45 in 360 cases suffered from local recurrence(12.5%,45/360),and 38 cases recurred within 3 years(84.4%).The univariate analysis revealed:The rates of local recurrence in the patients with primary lesion T3~4,TNM stage Ⅲ,or the number of axillary metastatic lymph node≥4 or without finishing radio-chemotherapy are significantly higher than those in the patients with primary lesion T1~2(P<0.01),TNM stage 0~Ⅱ(P<0.05)or the number of axillary metastatic lymph node≤3(P<0.01)or finishing radio-chemotherapy(P<0.01).There are no significant differences among the groups of different ages,pathological types and surgical procedures in statistical comparison(P>0.05).The multivariate Logistic analysis revealed:The number of axillary metastatic lymph node was positively correlated to the local recurrence(B=1.061,Sig=0.004).The more the number of axillary metastatic lymph node was,the higher the rate of local recurrence would be.whether finish radio-chemotherapy was negatively correlated with the local recurrence(B=-0.756,Sig=0.036).The patients without finishing radio-chemotherapy had high rate of local recurrence,and those with finishing radio-chemotherapy had lower rate of local recurrence.Conclusion The local recurrence after radical operation for breast cancer is significantly related with primary lesion diameter,TNM stage,the number of axillary metastatic lymph node and postoperative radio-chemotherapy.The high risk factors are the number of axillary metastatic lymph node≥4 and without finishing radio-chemotherapy.Early being found,diagnosis,treatment,and finishing postoperative radio-chemotherapy may efficiently decrease the rate of local recurrence.