乳腺癌根治术后单纯胸壁复发的治疗与预后

Treatment and prognostic analysis of isolated chest wall recurrence of breast cancer after mastectomy

目的探讨乳腺癌根治术后单纯胸壁复发(ICWR)患者的最佳治疗模式和预后影响因素。方法回顾性分析1998年10月至2018年4月中国医学科学院肿瘤医院和解放军总医院第五医学中心收治的201例乳腺癌改良根治术后ICWR患者的临床病理资料,中位随访92.8个月,获取患者的生存资料。结果201例ICWR患者中,103例发生再次局部区域复发(sLRR),5年sLRR率为49.1%;134例发生远处转移(DM),5年DM率为64.4%;103例死亡,中位无进展生存时间(PFS)为17.4个月,5年无进展生存率为23.2%,中位总生存时间(OS)为62.5个月,5年总生存率为52.1%。多因素分析显示,复发间隔时间(HR=2.17,95%CI:1.26~3.73)和局部治疗方式(HR=1.59,95%CI:1.05~2.40)是sLRR的独立影响因素,初诊人表皮生长因子受体2(HR=1.60,95%CI:1.03~2.48)是DM的独立影响因素,复发间隔时间(HR=1.99,95%CI:1.30~3.04)、局部治疗方式(HR=1.99,95%CI:1.43~2.76)及复发后治疗模式(HR=1.70,95%CI:1.18~2.46)是无进展生存的独立影响因素,初诊人表皮生长因子受体2(HR=1.69,95%CI:1.02~2.81)、复发间隔时间(HR=1.85,95%CI:1.15~2.98)及复发后治疗模式(HR=2.48,95%CI:1.56~3.96)是总生存的独立影响因素。结论在现代治疗背景下,乳腺癌根治术后ICWR患者有较高的5年总生存率,但sLRR和DM风险依然较高。包含放疗、手术在内的局部治疗联合全身治疗可以改善乳腺癌根治术后ICWR患者的预后。

Objective To analyze the prognostic factors of breast cancer patients with isolated chest wall recurrence(ICWR)after mastectomy,and investigate the optimal treatment.Methods A total of 201 breast cancer patients with ICWR after mastectomy who were treated in Cancer Hospital,Chinese Academy of Medical Sciences and the Fifth Medical Center Chinese PLA General Hospital from October 1998 to April 2018 were retrospectively analyzed.The median follow-up was 92.8 months and survival data were obtained.Results Among 201 patients with ICWR,103 patients developed subsequent locoregional recurrence(sLRR)and 5-year cumulative sLRR rate was 49.1%;134 patients developed distant metastasis(DM)and 5-year DM rate was 64.4%;103 patients died,the median progression-free survival(PFS)was 17.4 months and the 5-year PFS rate was 23.2%;the median overall survival(OS)was 62.5 months and the 5-year OS rate was 52.1%.Multivariate analysis showed that the recurrence interval(HR=2.17,95%CI:1.26-3.73)and the locoregional treatment(HR=1.59,95%CI:1.05-2.40)were the independent prognostic factors for sLRR.The initial HER2 status(HR=1.60,95%CI:1.03-2.48)was the independent prognostic factor for DM.The recurrence interval(HR=1.99,95%CI:1.30-3.04),the locoregional treatment(HR=1.99,95%CI:1.43-2.76)and the treatment modalities after recurrence(HR=1.70,95%CI:1.18-2.46)were the independent prognostic factors for PFS.The initial HER2 status(HR=1.69,95%CI:1.02-2.81),the recurrence interval(HR=1.85,95%CI:1.15-2.98)and the treatment modalities after recurrence(HR=2.48,95%CI:1.56-3.96)were the independent prognostic factors for OS.Conclusions Breast cancer patients after ICWR have an optimistic OS until now,but the risk of sLRR and DM is high.Comprehensive treatment modalities including surgery,radiotherapy and systemic therapy improve the outcome of breast cancer patients with ICWR after mastectomy.