前哨淋巴结活检联合局部切除手术治疗老年乳腺癌病人的疗效及预后相关因素分析

Analysis of the efficacy of sentinel lymph node biopsy combined with local resection in the treatment of breast cancer and the prognostic factors in the elderly

目的分析前哨淋巴结活检联合局部切除手术治疗老年乳腺癌的临床效果,并分析影响预后的相关因素。方法收集2010年3月至2017年4月乳腺外科接诊的240例乳腺癌病人,所有病人均进行局部乳腺切除手术,其中进行前哨淋巴结活检+局部乳腺切除手术的乳腺癌病人为前哨淋巴结活检组,进行腋窝淋巴结清扫术+局部乳腺切除手术的乳腺癌病人为腋窝淋巴结清扫组。手术治疗后,记录病人的临床效果及并发症,所有病人随访28个月,记录预后情况并分析影响病人预后的因素。结果前哨淋巴结活检组病人术后肩关节外展角度明显大于腋窝淋巴结清扫组病人(P<0.01),住院时间明显短于腋窝淋巴结清扫组(P<0.01),术后上肢麻木、疼痛、上肢功能障碍、皮下积液、上肢水肿的发生率均较腋窝淋巴结清扫组病人低(P<0.01);2组病人28个月内无病生存率差异无统计学意义(P>0.05)。Logistic回归分析结果显示,人表皮生长因子受体2(HER-2)、分子分型是影响老年乳腺癌病人预后的独立危险因素(P<0.05)。结论前哨淋巴结活检联合局部乳腺手术切除术治疗乳腺癌效果理想,可明显降低并发症发生率,且并未增加病人的转移复发率。

Objective To analyze the effect of sentinel lymph node biopsy combined with local resection in the elderly patients with breast cancer,and to analyze the related factors of prognosis.Methods A total of 240 cases of breast cancer receiving breast surgery from March 2010 to April 2017 were collected.The patients who underwent sentinel lymph node biopsy plus local mastectomy were selected as sentinel lymph node biopsy group,and those undergoing axillary lymph node dissection plus local mastectomy were selected as axillary lymph node dissection group.After operation,the clinical effects and complications were recorded.All patients were followed up for 28 months.The prognosis was recorded and the influencing factors were analyzed.Results Compared with the axillary lymph node dissection group,sentinel lymph node biopsy group showed larger postoperative shoulder abduction angle(P<0.01),shorter hospitalization time(P<0.01),lower incidence rate of upper limb numbness,pain,upper limb dysfunction,subcutaneous effusion,upper limb edema(P<0.01).There was no significant difference in disease-free survival rate between the two groups within 28 months(P>0.05).Logistic regression analysis showed that human epithelial growth factor receptor 2(HER-2)and molecular typing were independent risk factors affecting the prognosis of elderly patients with breast cancer(P<0.05).Conclusions Sentinel lymph node biopsy combined with local mastectomy is an ideal treatment for breast cancer.It can significantly reduce the incidence of complications and does not increase the recurrence or metastasis.