乳腺癌术后局部区域复发患者预后的影响因素观察

Influencing factors observation of the prognosis of patients with local recurrence after breast cancer surgery

目的探讨乳腺癌术后局部区域复发患者预后的影响因素。方法回顾性分析2017年1月~2019年10月荆州市第三人民医院普外科收治的98例乳腺癌术后局部区域复发患者的临床资料。收集患者的基线资料,包括年龄、月经状态、术后无瘤生存间期、辅助放疗、辅助化疗、局部复发类型、孕激素受体、淋巴结转移、原发瘤临床分期、胸壁复发灶最大径、病理类型、后续手术情况。根据患者6个月内的预后情况,分成生存组(n=79)和死亡组(n=19),比较两组临床资料,经COX模型分析患者预后的影响因素。结果98例患者中,有79例(80.61%)生存,19例(19.39%)死亡。单因素分析结果显示,死亡组和生存组术后无瘤生存间期、局部复发类型、淋巴结转移、后续手术及泌乳素(PRL)、癌胚抗原(CEA)水平比较,差异有统计学意义(P<0.05)。COX回归模型分析结果显示,术后无瘤生存间期<2年(β=1.412,OR=4.104,95%CI=1.340~12.569)、胸壁弥漫性复发(β=1.398,OR=4.047,95%CI=1.701~9.629)、淋巴结转移(β=1.367,OR=3.924,95%CI=1.407~10.944)、PRL≥457.35 mIU/mL(β=2.420,OR=11.246,95%CI=1.889~66.952)、CEA≥1.35 ng/mL(β=2.676,OR=8.276,95%CI=2.346~89.880)是导致死亡的危险因素(P<0.05),而后续手术(β=-0.152,OR=0.859,95%CI=0.741~0.996)能降低死亡风险(P<0.05)。结论乳腺癌术后局部区域复发患者预后与术后无瘤生存间期、局部复发类型、淋巴结转移、后续手术有关。

Objective To explore the influencing factors of the prognosis of patients with local recurrence after breast cancer surgery.Methods The clinical data of 98 patients with local recurrence of breast cancer after surgery in the Department of General Surgery,Jingzhou Third People′s Hospital from January 2017 to October 2019 were retrospectively analyzed.Their baseline data were collected,including age,menstrual status,postoperative tumor-free survival interval,adjuvant radiotherapy,adjuvant chemotherapy,local recurrence type,progesterone receptor,lymph node metastasis,clinical stage of primary tumor,maximum diameter of chest wall recurrence,pathological type and follow-up operation.According to the prognosis of patients within 6 months,they were divided into survival group(n=79)and death group(n=19).The clinical data of the two groups were compared,and the influencing factors of prognosis were analyzed by COX model.Results In the 98 patients,79 patients(80.61%)survived and 19 patients(19.39%)died.The results of univariate analysis showed that the differences in tumor-free survival interval,local recurrence type,lymph node metastasis,follow-up surgery,and prolactin(PRL)and carcinaombryonic antigen(CEA)levels between the death group and the survival group were statistically significant(P<0.05).The result of COX regression model analysis showed that,tumor-free survival interval<2 years(β=1.412,OR=4.104,95%CI=1.340-12.569),diffuse recurrence of chest wall(β=1.398,OR=4.047,95%CI=1.701-9.629),lymph node metastasis(β=1.367,OR=3.924,95%CI=1.407-10.944),PRL≥457.35 mIU/mL(β=2.420,OR=11.246,95%CI=1.889-66.952),and CEA≥1.35 ng/mL(β=2.676,OR=8.276,95%CI=2.346-89.880)were risk factors of death(P<0.05).Follow-up surgery(β=-0.152,OR=0.859,95%CI=0.741-0.996)reduced the risk of death(P<0.05).Conclusion The prognosis of patients with local recurrence after breast cancer surgery is related to tumor free survival time,local recurrence type,lymph node metastasis and follow-up operation.