54例乳腺癌术后胸壁转移患者的临床特征及预后因素分析

Clinical features and prognosis of 54 breast cancer patients with chest wall recurrence after mastectomy

目的：探讨乳腺癌术后局部胸壁转移患者的临床特征、治疗方式及影响预后的因素。方法收集54例术后以胸壁复发为首发转移部位的乳腺癌患者的临床资料，分析各项临床和病理因素同局部控制率及生存期之间的关系；并搜索万方及Pubmed数据库中的相关文献，进行汇总分析。结果54例患者原发肿瘤术后无病生存期（DFS）为4～277个月，中位DFS为50个月。单纯胸壁转移患者局部复发后无进展生存期（PFS）2～120个月，中位PFS为21个月。单纯胸壁转移组的单因素分析结果显示患者的原发肿瘤病理类型、脉管癌栓情况、激素受体水平、HER2表达情况是原发肿瘤术后DFS及OS的相关预后因素；多因素分析结果显示原发肿瘤的病理类型、脉管癌栓情况、术后辅助放疗、辅助内分泌治疗及原发肿瘤术后DFS是总生存期的独立预后因素。结论乳腺癌术后局部复发将增加远处转移及死亡风险，明确高复发风险因素，采取全身综合治疗及局部治疗可改善患者预后。

Objective To analyze the clinical features, treatment modality and prognosis of breast cancer patients with chest wall recurrence （CWR） after mastectomy. Method The clinical-pathologic profiles of 54 breast cancer pa-tients with CWR were collected, and the relation between various clinical-pathological factors and local control, as well as survival, was investigated, besides, associated literatures were searched in the database of WANFANG and Pubmed and reviewed. Result Of all the 54 patients, the postoperative disease-free survival （DFS） was 4 to 277 months, with a median DFS of 50 months. For simple CWR patients, the progression-free survival （PFS） after CWR was 2 to 120 months, with a median PFS of 21 months. The univariate analysis showed that, the pathological type, blood vessel invasion, hormone receptor status and HER2 status were associated with the DFS and overall survival （OS）. And the multivariate analysis suggested that the pathological type, blood vessel invasion, postoperative radio-therapy, adjuvant endocrine therapy and the DFS after mastectomy were independent prognostic factors for OS. Con-clusion Postoperative chest wall breast cancer recurrence increases the risk of distant metastases and death, and sys-temic treatment combined with local treatment is beneficial in improving patients ’prognosis.