腋窝淋巴结状态对乳腺癌保乳手术后复发病人的预后影响

doi:10.3969/j.issn.1005-6483.2019.09.015

摘要/Abstract

摘要： 目的:探究腋窝淋巴结状态对乳腺癌保乳手术后复发病人的预后影响。方法:选取2012年4月～2015年5月南京市妇幼保健院收治的476例行乳腺癌保乳手术后复发的乳腺癌病人作为研究对象。根据做乳腺癌保乳手术时腋窝淋巴结的状态分为腋窝淋巴结阳性组152例和腋窝淋巴结阴性组324例。观察并比较两组病人临床病理表现、生存情况，并分析复发后预后影响因素。结果:两组病人的局部与区域复发情况差异无统计学意义（均P＞0.05）。两组病人的年龄、复发部位、雌激素受体（ER）及孕激素受体（PR）状态、人表皮生长因子受体2（HER2）状态、无病间期、局部治疗和全身治疗差异均无统计学意义（均P＞0.05）。两组病人无远处转移生存率差异无统计学意义（P＞0.05），而阳性组患总生存率明显低于阴性组（P＜0.05）。Cox比例风险模型多因素分析显示，复发部位是乳腺癌保乳手术局部区域复发后无远处转移生存的独立影响因素（OR=2.052，P=0.003），腋窝淋巴结状态和复发部位是乳腺癌保乳手术局部区域复发后总生存的独立影响因素（OR=3.468，P=0.003；OR=677，P＜0.001）。结论:腋窝淋巴结状态是乳腺癌保乳手术后复发病人总生存的独立影响因素，但对病人的无远处转移生存影响较小。

关键词: 乳腺肿瘤, 乳腺癌保乳手术, 腋窝淋巴结, 局部复发, 区域复发, 预后

Abstract: Objective:To investigate the effect of axillary lymph node status on the prognosis of patients with recurrence after breast conserving surgery.Methods:From April 2012 to May 2015，476 patients with breast cancer who had recurred after breast conserving surgery were selected as the study subjects.According to the status of axillary lymph nodes during breast conserving surgery，152 cases were axillary lymph node positive group and 324 cases axillary lymph node negative group.The clinicopathological manifestations and survival of the two groups were observed and compared，and the prognostic factors after recurrence were analyzed.Results:There was no significant difference in local and regional recurrence between the two groups（P>0.05）.There were no significant differences in age，recurrence site，estrogen receptor（ER）and progesterone receptor（PR），human epidermal growth factor receptor 2（HER2），diseasefree interval，local and systemic treatment between the two groups（all P>0.05）.There was no significant difference in the nondistant metastasis survival rate between the two groups（P>0.05），but the total survival rate in the positive group was significantly lower than that in the negative group（P<0.05）.Cox proportional hazard model multivariate analysis showed that recurrence site was an independent factor for survival without distant metastasis after local recurrence of breast conserving surgery（OR=2.052，P=0.003）.Axillary lymph node status and recurrence site were independent factors for overall survival after local recurrence of breast conserving surgery（OR=3.468，P=0.003；OR=677，P<0.001）.Conclusion:Axillary lymph node status is an independent factor affecting the overall survival of patients with recurrence after breast conserving surgery，but it has little effect on the survival of patients without distant metastasis.

Key words: breast neoplasms, breast conserving surgery, axillary lymph nodes, local recurrence, regional recurrence, prognosis

周萍, 许楠, 陆澄. 腋窝淋巴结状态对乳腺癌保乳手术后复发病人的预后影响[J]. 临床外科杂志, 2019, 27(9): 769-772.

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