乳腺癌术后局部复发因素的探讨

Analysis of Local Recurrence in Breast Cancer after Mastectomy

目的乳腺癌术后局部复发率为10%～30%,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3.8%,其中22例(56.4%)在手术后2年内复发。T1～T4复发率分别为1.9%、2.3%、9.5%和16.7%。腋窝淋巴结(-)与腋窝淋巴结(+)患者的胸壁复发率分别为1.2%、5.6%,腋窝淋巴结转移≥3个者复发率高达13.5%,新辅助化疗、术后放疗的患者复发率分别为2.1%、8.1%。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。

Objective The local recurrent rate of breast cancer after mastectomy was 10%～30%,even 34%～40% in those with high risk factors. Of them, chest wall recurrence was the most common. This paper aims to explore the risk factors for chest wall recurrence after mastectomy,hoping to find an efficient way to prevent and reduce this complication.Methods 39 patients with local recurrence but no metastasis after mastectomy were retrospectively reviewed.Results They account for 5.1% of all patients with breast cancer patients in the same period. Of them, 22 recurred within 2 years after operation. The recurrent rate of T1～T4 was 1.9%、2.3%、9.5% and 16.7% respectively. Recurrence rate of chest wall in patients with or without axillary nodes metastasis was 5.6% and 1.2%. Moreover, if the number of positive axillary nodes was more than 4,the recurrence rate got 13.5%. Recurrence rate in patients who underwent neoadjuvant chemotherapy and postoperation radiotherapy was 2.1% an 8.1% respectively, which was much lower than that in patients didn’t received any other intervene besides operation.Conclusion 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. Patients with high risk factors of recurrence after mastectomy should be administered standardized therapy. Neoadjuvant chemotherapy and postoperative radiotherapy are efficient ways to prevent recurrence on the chest wall.