乳腺癌术后胸壁复发39例临床分析

The clinical analysis of chest wall recurrence of breast cancer after mastectomy

背景与目的：乳腺痛术后局部复发率为5％-20％，合并高危因素者可达34％-40％，其中以胸壁复发最为常见。本文探讨乳腺癌术后胸壁局部复发的相关因素，寻找预防和降低乳腺癌术后胸壁复发的有效措施。方法：回顾性分析乳腺癌术后局部复发而无远处转移的39例患者的临床资料。结果：本组患者占同期全部乳腺癌病例的5．1％，其中23例（59．0％）在手术后2年内复发。T1～T4复发率分别为1．6％、1．9％、9．7％和37．2％，腋窝淋巴结（-）与腋窝淋巴结（＋）患者的胸壁复发率分别为1．3％、7．6％，腋窝淋巴结转移≥4个者复发率高达13．4％，新辅助化疗、术后放疗的患者复发率分别为3．8％、8．7％。明显低于未予相应治疗者。结论：腋窝淋巴结转移数目多、原发灶分期晚、未予恰当辅助治疗者易出现胸壁复发。对乳腺癌术后易复发的高危人群应规范化治疗，新辅助化疗、术后放疗是预防胸壁复发的有效措施。

Background and Purpose： The recurrent rate of breast cancer after mastectomy was 5% -20%, high risk factors were included it could achieve 34%- 40%, Chest wall recurrence was the most common. This paper explores the reason for chest wall recyrrence of breast cancer after mastectomy, hoping to find an efficient way to prevent and reduce chest wall recurrence after mastectomy. Methods： For 39 patients with local recurrence on the chest wall after mastectomy clinical data was reviewed retrospectively. Results： This group of patients was 5.1% of all breast cancer patients in the same period. Most of recurrences（59.0%）occured within two years affer operation. The recurrent rate of T1 -T4 was 1.6% ,1. 9% ,9.7% and 37.2% respectively. Rate of chest wall recurrence in patients with negative axillary nodes and positive axillary nodes was i. 3% ,7.6%, but if the amount of positive axillary nodes≥4, it was 13.4%. Conclusions： In the patients who had more, positive axillary nodes, larger primary tumor and no proper adjuvant therapy, recurrence on the chest wall was seen more often. Adjuvant chemotherapy and postoperative radiotherapy are efficient ways to prevent recurrence on the chest wall.