乳腺叶状肿瘤局部复发的临床风险因素分析

目的分析乳腺叶状肿瘤局部复发的临床风险因素。方法使用SPSSCox比例风险模型分析2002年12月至2008年12月中国医科大学附属第一医院66例乳腺叶状肿瘤患者各种临床风险因素与局部复发的关系。单因素分析采用X2检验。结果本组患者的发病年龄为17—83岁（中位年龄41岁），良性40例，交界性24例，恶性2例。局部复发15例，其中12例复发发生于区段切除术。在不同手术方式、不同组织学等级的叶状肿瘤患者之间，复发率的差异均有统计学意义（P〈0．05）。手术方式为保护因素（RR=0．151），扩大切除术和乳房切除术者的复发风险较区段切除术者下降至66／1000和53／1000；组织学等级为危险因素（RR=5．803），恶性和交界性叶状肿瘤患者的局部复发风险分别为良性肿瘤者的12．26倍和4．37倍。结论恶性程度高和手术方式选择不当影响预后。叶状肿瘤以手术治疗为首选，应选择切除范围扩大的手术方式，尤其是对恶性程度高的患者。

Analysis on clinical risk factors of local recurrence in breast phyllode tumor

Objective To analyze the clinical risk factors for local recurrence of breast phyllodes tumors.Methods The data of 60 cases of breast phyllodes tumor enrolled in China Medical University from December 2002 to December 2008 were analyzed.The correlation of clinical risk factors with local recurrence were analyzed by SPSS Cox’s proportional hazard regression model.Chi-square test was used for single factor analysis.Results The median age of the patients was 41 years(range:17 to 83 years).Tumors were benign in 40 cases,borderline in 24 cases and malignant in 2 cases.In 15 cases with local recurrence,12 cases underwent segmental excision.The recurrence showed statistical difference among the patients with different histological grade or undergoing different surgeries(P<0.05).Cox’s analysis revealed that surgical treatments were favorable factors for local recurrence,and the recurrence risk of extended resection and mastectomy was 66/1000 and 53/1000 respectively,lower than that of segmental resection.However,histological grade was a risk factor,and the recurrence risk of malignant tumor and borderline tumor was 12.26 and 4.37 times of that of benign tumor respectively.Conclusions Histological grade and surgical treatment have an effect on prognosis.Extended excision is the first choice for breast phyllodes tumors,especially for those with higher histological grade.