乳腺癌保留乳房治疗局部复发风险因素回顾性分析

Retrospective analysis of related factors of local recurrence after conserving therapy in early breast cancer

目的:探讨早期乳腺癌保留乳房术后局部复发的临床病理危险因素。方法:收集我院1998-09-01-2011-07-31收治的临床0～Ⅱ期行保留乳房手术的146例早期乳腺癌患者的病例资料,采用Cox检验对患者年龄、肿瘤大小、淋巴结状态、雌激素受体(ER)表达、孕激素受体(PR)表达、人类表皮生长因子受体2(HER-2)表达和分子分型与术后局部复发的相关性进行单因素和多因素分析。结果:中位随访61个月,9例患者首发出现患侧乳房局部复发,生存分析显示3年和5年累积局部复发率分别为6.3%和7.5%。患者年龄、肿瘤大小、ER/PR表达状态和分子分型与术后局部复发无明显相关性,P>0.05。HER-2阳性(P=0.002 1)和淋巴结阳性(P=0.03)与局部复发有相关性,且是独立影响因素。结论:HER-2阳性和淋巴结阳性是乳腺癌保留乳房术后局部复发的独立预后高危因素,而患者年龄、肿瘤大小、激素受体表达状态和局部复发无显著相关性。

OBJECTIVE：To study the related clinical and pathologic factors of local recurrence after conserving therapy in early-stage breast cancer. METHODS： From September 1st, 1998 to July 31st, 2011,146 patients with clinical Stage 0-Ⅱbreast cancer who received breast conserving therapies（BCT） were analyzed retrospectively. Risk factors such as age, primary tumor size, axillary lymph node metastasis, estrogen receptor （ER） expression, progesterone receptor （PR） expression,human epidermal growth factor 2 （HER-2） expression and molecular subtypes associated with local recurrence were analyzed using Cox regression model. RESULTS：With a median follow-up of 61 months,ipsilateral local recurrences were detected as the first site of recurrence in 9 patients. Accumulated 3-year and 5-year local recurrence rate after BCT were 6.3 % and 7.5 %. Those factors including age,tumor size,ER/PR expressions and molecular subtypes had no domihal statistical differences for local recurrence （P〉0.05）. HER-2 positive status （P = 0. 002 1） and positive lymph node metastasis （P= 0.03） were high risk factors and also independent factors for local recurrence. CONCLUSION： HER-2 positive status and positive lymph node metastasis are independent prognostic high risk factors for local recurrence after BCT, whereas no significant differences are observed in different age,tumor size and ER/PR expressions for local recurrence.