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中华乳腺病杂志(电子版) ›› 2012, Vol. 06 ›› Issue (03) : 264 -271. doi: 10.3877/cma. j. issn.1674-0807.2012.03.005

论著

乳腺叶状肿瘤局部复发的临床风险因素分析
张明迪1, 郑新宇1,()   
  1. 1.110001 沈阳,中国医科大学附属第一医院乳腺外科
  • 收稿日期:2011-04-22 出版日期:2012-06-01
  • 通信作者: 郑新宇

Analysis on clinical risk factors of local recurrence in breast phyllode tumor

Ming-di ZHANG1, Xin-yu ZHENG1,()   

  1. 1.Department of Breast Surgery, First Affiliated Hospital, China Medical University, Shenyang 110001, China
  • Received:2011-04-22 Published:2012-06-01
  • Corresponding author: Xin-yu ZHENG
引用本文:

张明迪, 郑新宇. 乳腺叶状肿瘤局部复发的临床风险因素分析[J/OL]. 中华乳腺病杂志(电子版), 2012, 06(03): 264-271.

Ming-di ZHANG, Xin-yu ZHENG. Analysis on clinical risk factors of local recurrence in breast phyllode tumor[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2012, 06(03): 264-271.

目的

分析乳腺叶状肿瘤局部复发的临床风险因素。

方法

使用SPSS Cox 比例风险模型分析2002 年12 月至2008 年12 月中国医科大学附属第一医院66 例乳腺叶状肿瘤患者各种临床风险因素与局部复发的关系。 单因素分析采用χ2 检验。

结果

本组患者的发病年龄为17 ~83 岁(中位年龄41 岁),良性40 例,交界性24 例,恶性2 例。 局部复发15 例,其中12 例复发发生于区段切除术。 在不同手术方式、不同组织学等级的叶状肿瘤患者之间,复发率的差异均有统计学意义(P<0.05)。 手术方式为保护因素(RR=0.151),扩大切除术和乳房切除术者的复发风险较区段切除术者下降至66/1000 和53/1000;组织学等级为危险因素(RR=5.803),恶性和交界性叶状肿瘤患者的局部复发风险分别为良性肿瘤者的12.26 倍和4.37 倍。

结论

恶性程度高和手术方式选择不当影响预后。 叶状肿瘤以手术治疗为首选,应选择切除范围扩大的手术方式,尤其是对恶性程度高的患者。

Objective

To analyze the clinical risk factors for local recurrence of breast phyllodes tumors.

Methods

The data of 60 cases of breast phyllodes tumor enrolled in China Medical University from December 2002 to December 2008 were analyzed. The correlation of clinical risk factors with local recurrence were analyzed by SPSS Cox’ s proportional hazard regression model. Chi-square test was used for single factor analysis.

Results

The median age of the patients was 41 years (range: 17 to 83 years). Tumors were benign in 40 cases, borderline in 24 cases and malignant in 2 cases. In 15 cases with local recurrence,12 cases underwent segmental excision. The recurrence showed statistical difference among the patients with different histological grade or undergoing different surgeries(P<0.05). Cox’s analysis revealed that surgical treatments were favorable factors for local recurrence, and the recurrence risk of extended resection and mastectomy was 66/1000 and 53/1000 respectively, lower than that of segmental resection. However,histological grade was a risk factor,and the recurrence risk of malignant tumor and borderline tumor was 12.26 and 4.37 times of that of benign tumor respectively.

Conclusions

Histological grade and surgical treatment have an effect on prognosis. Extended excision is the first choice for breast phyllodes tumors, especially for those with higher histological grade.

图1 双乳各象限乳腺叶状肿瘤发生例数
图2 乳腺叶状肿瘤患者的影像学检查结果
表1 40 例良性乳腺叶状肿瘤局部复发与手术方式的关系
表2 40 例良性乳腺叶状肿瘤局部复发与术式关系的Cox 回归分析
表3 乳腺叶状肿瘤局部复发与各临床因素的关系
表4 影响乳腺叶状肿瘤局部复发的多因素Cox 回归分析
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