目的

研究乳腺癌根治术局部复发后影响预后的相关因素,探讨乳腺癌根治术后局部复发的最佳治疗方案。

方法

回顾性分析天津肿瘤医院1975年1月至2003年1月期间收治的1067例乳腺癌根治术后复发患者,采用χ² 检验或秩和检验对患者年龄、绝经情况、原发瘤临床分期、腋窝淋巴结转移情况、无病间期、复发部位、胸壁复发灶数目及其最大直径、雌激素受体(ER)或孕激素受体(PR)表达、人类表皮生长因子受体2(HER-2)表达等临床病理特征以及不同治疗方案与局部复发治疗的近期疗效和远处转移率之间的关系进行单因素分析;使用Kaplan-Meier法及COX回归模型对乳腺癌根治术复发后影响5年生存率的相关因素进行单因素与多因素分析。

结果

对全部1067例病例进行随访,778例(72.9%)出现远处转移,复发后5年总生存率为42.4%。复发部位、胸壁复发灶数目及其最大直径、有无放射治疗、放射治疗范围、有无化疗、有无手术切除或切除活检等因素的不同亚组间局部控制率的差异有统计学意义(P＜0.050);腋窝淋巴结转移情况、无病间期、ER或PR表达、HER-2表达以及再治疗中有无化疗等因素的不同亚组间远处转移率的差异有统计学意义(P＜0.050);无病间期、复发部位、胸壁复发灶数目、ER或PR表达、HER-2表达、治疗方法等因素的不同亚组间5年总生存率的差异有统计学意义(P＜0.050);无病间期≤2年、复发部位多、治疗方案单一、局部控制率低及ER、PR均阴性是导致复发性乳腺癌预后差的独立因素(P＜0.050)。

结论

多部位复发、胸壁多发结节及胸壁复发灶最大直径＞3 cm 者局部控制不佳,局部扩大野放射治疗结合化疗和(或)手术是改善局部控制率的较好模式;有腋窝淋巴结转移、2年内复发、ER、PR均阴性以及HER-2阳性表达的乳腺癌复发后容易发生远处转移,复发再治疗中化疗能减少远处转移的发生;对于复发性乳腺癌采取综合治疗方案可以提高复发患者的生存率;无病间期长,多部位复发,ER或PR阴性者提示预后不良。

Objective

To study the prognosis-related factors of local recurrence after radical mastectomy for breast cancer,and explore an optimal treatment for local recurrence after radical mastectomy.

Methods

One thousand and sixty-seven patients with breast cancer recurrence who had undergone radical surgery in Tianjin Cancer Hospital From January 1975 to January 2003 were retrospectively analyzed.The age,menopausal status,clinical stage of primary tumor,axillary lymph node metastasis,disease-free interval,recurrence site,foci of chest wall recurrence and its largest diameter,estrogen receptor(ER)and progesterone receptor(PR)expressions,human epidermal growth factor receptor 2(HER-2)expression and other clinicopathological characteristics,and the relationship between different treatment programs and the short-term therapeutic effect of local recurrence and distant metastasis were analyzed using Chi-square test or rank sum test.Kaplan-Meier method and COX regression model were applied to analyze the relevant factors of 5-year survival rate of patients with breast cancer recurrence after radical mastectomy.

Results

The follow-up of the 1067 patients showed that 778 cases(72.9%)had distant metastasis,with the overall 5-year survival rate after recurrence being 42.4%.There was a statistical difference in local control rates in recurrence site,the number and diameter of chest wall recurrence foci,patients with or without radiotherapy,the radiotherapy range,patients with or without chemotherapy,and patients with or without surgical resection biopsy or excisional biopsy between different subgroups(P＜0.050).There was a statistical difference in distant metastasis rate in axillary lymph node metastasis,disease-free interval,ER and PR expressions,HER-2 expression,and patients with re-treatment with or without chemotherapy between different subgroups(P ＜0.050).There was a statistical difference in 5-year survival rate in disease-free interval,recurrence site,the number of chest wall recurrence foci,ER or PR expression,HER-2 expression,and treatment methods between different subgroups(P ＜0.050).Disease-free interval≤2 years,multi-site recurrence,single treatment option,low local control rate,and negative ER and PR were the independent factors causing poor prognosis for recurrent breast cancer(P ＜0.050).

Conclusion

Multi-site recurrence,chest wall recurrence with multiple nodules and the chest wall recurrence ＞3 cm in diameter lead to a poor local control.Local expansion of radiotherapy combined with chemotherapy and/or surgery is a better mode to improve the local control rate.Patients with axillary lymph node metastasis,recurrence within 2 years,negative ER and PR,and positive expression of HER-2 are likely to have distant metastasis after breast cancer recurrence.Retreatment with chemotherapy for recurrence can reduce the incidence of distant metastasis.For recurrent breast cancer,combined treatment program can improve the survival rate.A long disease-free interval,multi-site recurrence,negative ER or PR imply a poor prognosis.