乳腺区段切除术治疗老年乳腺癌的临床效果及预后高危因素分析

Clinical Effect and Prognostic Risk Factors of Segmental Mastectomy for Elderly Breast Cancer

目的探讨乳腺区段切除术治疗老年乳腺癌的临床效果及预后影响因素。方法回顾性分析90例老年乳腺癌患者临床资料,所有患者均行乳腺区段切除术治疗。术后以乳腺癌生存质量量表(QLS-BC)评价所有患者生存质量变化,并随访2年,依据术后是否出现复发转移分为预后差组及预后良好组。收集2组基础资料,通过开展Logistic回归分析,最终获取影响老年乳腺癌患者手术预后的独立因素。结果90例老年乳腺癌患者术后QLS-BC评分中各项因子评分[(65.89±7.04)分、(51.36±5.21)分、(119.85±12.85)分、(39.85±4.27)分]及总分[(276.95±24.59)分]均高于术前,差异有统计学意义(P<0.05)。90例患者经2年随访,共16例出现复发转移;多因素分析显示,细胞增殖核抗原Ki67>14%、孕激素受体(PR)/雌激素受体(ER)阳性未进行内分泌治疗为影响老年乳腺癌患者手术预后的独立危险因素(P<0.05且OR>1)。结论乳腺区段切除术在老年乳腺癌患者的治疗中效果确切,能有效改善患者生存质量,但Ki67>14%、PR/ER阳性未进行内分泌治疗等与术后复发转移相关,临床需开展针对性干预,完善治疗方案,降低复发转移风险。

Objective To explore the clinical effect and prognostic factors of segmental mastectomy in the treatment of elderly breast cancer.Methods Clinical data of 90 elderly patients with breast cancer were retrospectively analyzed.All patients underwent segmental mastectomy.The quality of life of all patients was evaluated with the breast cancer quality of life scale(QLS-BC)after surgery,and were followed up for 2 years.They were divided into poor prognosis group and good prognosis group according to whether there was recurrence and metastasis after surgery.Basic data of the 2 groups were collected and logistic regression analysis was carried out to finally obtain the independent factors affecting the surgical prognosis of elderly breast cancer patients.Results All the factors[(65.89±7.04),(51.36±5.21),(119.85±12.85),(39.85±4.27)]and the total score[(276.95±24.59)]of QLS-BC score in 90 elderly patients with breast cancer after operation were significantly higher than those before operation(P<0.05).After 2 years of follow-up,a total of 16 out of 90 patients experienced recurrence and metastasis;Multivariate analysis showed that cell proliferating nuclear antigen Ki67>14%,progesterone receptor(PR)/estrogen receptor(ER)positive without endocrine therapy were independent risk factors affecting the prognosis of elderly patients with breast cancer(P<0.05 and OR>1).Conclusion Segmental mastectomy is effective in the treatment of elderly patients with breast cancer and can improve their quality of life,but Ki67>14%,PR/ER positive and no endocrine therapy are related to postoperative recurrence and metastasis,so targeted intervention should be carried out to improve the treatment plan and reduce the risk of recurrence and metastasis.