原发性乳腺癌患者保乳术后局部复发的相关因素分析

Analysis of Related Factors for Local Recurrence after Breast Conserv⁃ing Surgery in Patients with Primary Breast Cancer

目的探究保乳术后局部复发的相关危险因素,为合理提高早期原发性乳腺癌患者保乳术率及降低保乳术后局部复发风险提供科学依据。方法回顾性分析2011年1月—2018年9月于重庆医科大学附属第一医院行保乳术的原发性乳腺癌患者652例的临床病理资料,并进行单因素及多因素分析。结果652例乳腺癌患者,随访事件终点为发生局部复发,共计失访人数43例(随访率为93.4%),中位随访时间为120个月。发生局部复发的患者共37例(复发率为6.1%)。单因素分析结果显示:年龄、生育史、经期状态、肿瘤部位、肿瘤大小、病理类型及腋窝淋巴结状态对局部复发无影响(P>0.05),ER状态、PR状态、KI67表达水平、HER-2状态及分子分型对局部复发有影响(P<0.05);多因素分析结果显示:当分子分型为HER-2过表达型及三阴型时是保乳术后发生局部复发的独立危险因素(P<0.05)。结论HER-2过表达型、三阴型可作为预测保乳术患者局部复发的独立因素,针对HER-2过表达、三阴型乳腺癌患者行保乳术应更加谨慎。

Objective To explore the relevant risk factors of local recurrence after breast-conserving surgery,and to provide scientific basis for rationally increasing the rate of breast-conserving surgery and reducing the risk of local recurrence after breast-conserving surgery in patients with early primary breast cancer.Methods The clinical data of 652 patients with primary breast cancer who underwent breast conserving surgery in the First Affiliated Hospital of Chongqing Medical University from January 2011 to September 2018 were retrospectively analyzed,and univariate and multivariate analyses were performed.Results A total of 652 breast cancer patients,the end point of the followup event was the occurrence of local recurrence.A total of 43 patients were lost to follow-up(the follow-up rate was 93.4%).The median follow-up was 120 months.A total of 37 patients developed local recurrence(recurrence rate 6.1%).Univariate analysis showed that age,reproductive history,menstrual status,tumor location,tumor size,patho‐logical type and axillary lymph node status had no effect on had influence on local recurrence(P>0.05),ER status,PR status,KI67 expression level,HER-2 status and molecular type had influence local recurrence(P<0.05).The re‐sults of multivariate analysis showed that HER-2 overexpression type and triple negative type were independent risk factors for local recurrence after breast conserving surgery(P<0.05).Conclusion HER-2 overexpression and triplenegative breast cancer can be used as independent factors for predicting local recurrence in patients with breastconserving surgery.Breast-conserving surgery should be more cautious in patients with HER-2 over-expressing and triple-negative breast cancer.