早期乳腺癌原发象限对根治术后1～3个腋窝淋巴结转移患者预后预测价值探讨

Prognostic value of primary tumor site in early breast cancer patients with one to three positive axillary lymph nodes after radical surgery

目的：探讨早期乳腺癌原发象限对根治术后1～3个腋窝淋巴结转移患者LRR的预测价值。方法回顾分析1998—2010年在本院手术的656例病理诊断为pT1.2 N1 M0期且均未术后放疗患者资料。原发肿瘤位于内象限156例、中央区45例、外象限455例。观察终值为 LRR 和 LRFS。Kaplan-Meier法计算LRR、LRFS并Logrank检验和单因素预后分析， Cox模型多因素预后分析。结果5、10年样本数分别为416、191例，5、10年LRR分别为8.6％、12.9％，LRFS分别为86.2％、76.4％。单因素分析显示年龄、pT分期、Ki67水平、分子分型和肿瘤位置是影响 LRR 因素（ P＝0.000、0.006、0.017、0.004、0.000）。多因素分析显示年龄、肿瘤位置和分子分型也是LRFS的预后影响因素（ P＝0.0012、0.012、0.005），且随危险因素增加（危险因素≥2个），原发内象限患者LRR迅速升高，LRFS降低，原发外象限、中央区者则无变化。结论肿瘤原发象限对早期乳腺癌根治术后pT1.2 N1 M0期患者LRR和LRFS有预测价值。肿瘤位于内象限者LRR高、LRFS低，对高危组患者复发风险的预测价值更大。

Objective To explore the predictive value of primary tumor site for loco.regional recurrence （ LRR） in early breast cancer patients with one to three positive axillary lymph nodes after radical surgery. Methods The clinical data of 656 patients pathologically diagnosed with pT1.2 N1 M0 breast cancer who received radical surgery without postoperative radiotherapy in our hospital from 1998 to 2010 were retrospectively analyzed. In those patients, 156 had primary tumor located in the inner quadrant, 45 in the central quadrant, and 455 in the outer quadrant. LRR and local recurrence.free survival （ LRFS） were end points. The Kaplan.Meier method was used to estimate LRR and LRFS rates. The log.rank test was used for survival difference analysis and univariate prognostic analysis. Multivariate analysis was performed using the Cox regression model. Results The 5.and 10.year sample sizes were 416 and 191, respectively. The 5.and 10.year LRR rates were 8.6% and 12.9%, respectively, while the 5.and 10.year LRFS rates were 86.2%and 76.4%, respectively. The univariate analysis indicated that age, pT stage, Ki67 level, molecular classification, and primary tumor in the inner quadrant were significant influencing factors for LRR （ P=0.000,0.006,0.017,0.004,0.000）. The multivariate analysis showed that age no greater than 35 years, primary tumor in the inner quadrant, and non.luminal subtype in molecular classification were independent prognostic factors for LRR and LRFS （ P=0.0012,0.012,0.005） . With an increasing number of risk factors （ ≥2 ） , patients with primary tumor in the inner quadrant had a dramatically increased LRR rate and a＆amp;nbsp;reduced LRFS rate, while patients with primary tumor in the outer or central quadrant kept the same LRR and LRFS rates. Conclusions The primary tumor site holds promise for prediction of LRR and LRFS in patients with pT1.2N1M0 breast cancer after radical surgery. Patients with primary tumor located in the inner quadrant have a high LRR rate and a low LRFS rate, which provides an excellent predictor for the risk of recurrence in patients with high.risk breast cancer.