乳腺癌患者术后远处转移及其不良结局的危险因素

目的探讨乳腺癌患者术后发生远处转移及其不良结局的危险因素。 方法回顾分析2012年1月至2015年10月期间行手术治疗后发生术后远处转移67例和未发生远处转移130例的女性乳腺癌患者病例资料，随访时间截止2020年10月。采用SPSS 22.0统计软件包分析数据，单因素生存分析采用K-M法，行Log-rank检验；Cox回归模型分析乳腺癌术后转移的多因素分析。 结果脉管状态、组织学分级、肿瘤大小、淋巴结阳性数及化疗方案和靶向治疗是影响乳腺癌术后远处转移的独立危险因素（P<0.05）。67例远处转移患者死亡48例，存活19例，中位生存时间为39个月。多因素分析显示，脉管状态、肿瘤大小、临床分期、组织学分级、转移数目、Her-2状态及化疗方案和靶向治疗是影响远处转移患者预后不良的独立危险因素（P<0.05）。 结论发生脉管癌栓、肿瘤直径越大、临床分期和组织学分级越高、多部位转移、Her-2阳性是影响远处转移患者预后的独立危险因素，术后蒽环类联合紫杉类化疗可以降低远处转移率，提高患者预后。

Risk factors for distant metastasis and adverse outcomes in patients with breast cancer after surgery

ObjectiveTo investigate the risk factors for distant metastasis and adverse outcomes in patients with breast cancer after surgery. MethodsThe data of 67 breast cancer patients with distant metastasis and 130 breast cancer patients without distant metastasis who underwent surgical treatment from January 2012 to October 2015 were retrospectively analyzed，and the follow-up time was up to October 2020. SPSS 22.0 statistical software package was used to analyze the data. K-M method was used for univariate survival analysis，and Log-rank test was performed；Multivariate analysis of postoperative metastasis of breast cancer by Cox regression model. ResultsVescularization status，histological grade，tumor size，positive number of lymph nodes，chemotherapy regimen and targeted therapy were independent risk factors for distant metastasis after breast cancer（P<0.05）.Of the 67 patients with distant metastasis，48 died，19 survived，and the median survival time was 39 months. Multiariate analysis showed that vascular status，tumor size，clinical stage，histological grade，number of metastases，HER-2 status，chemotherapy regimen and targeted therapy were independent risk factors for poor prognosis in patients with distant metastasis（P<0.05）. ConclusionOccurrence of vascular thrombosis，larger tumor diameter，higher clinical stage and histological grade，multi-site metastasis，and positive HER-2 are independent risk factors for prognosis of patients with distant metastasis. Postoperative anthracyclines combined with taxol chemotherapy can reduce the rate of distant metastasis and improve the prognosis of patients.