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目的 探讨术后局部区域复发(LRR)的乳腺癌患者发生远处转移及生存的预后因素.方法 回顾性分析中国医科大学附属第一院肿瘤内科61例行改良根治术,术后发生首次LRR患者的临床资料,分析影响乳腺癌患者发生LRR后的远处转移及生存的临床病理因素.结果 单因素分析显示,三阴性、HER2过表达型乳腺癌、手术至LRR间隔时间≤2年、LRR后未行手术切除LRR病灶是影响LRR乳腺癌患者发生远处转移及生存的高危因素.多因素分析显示,三阴性乳腺癌、HER2过表达型乳腺癌、LRR后未行手术切除是LRR乳腺癌患者发生远处转移的独立高危因素.其中,三阴性乳腺癌、HER2过表达型乳腺癌LRR后远处转移风险分别为Luminal A/B(HER2阴性)乳腺癌的3.58倍和2.87倍.此外,三阴性乳腺癌、HER2过表达型乳腺癌同时是影响复发后生存的独立高危因素,其死亡风险分别为Luminal A/B(HER2阴性)型的3.886倍和3.097倍.结论 三阴性乳腺癌、HER2过表达型乳腺癌是LRR乳腺癌患者发生远处转移及生存的独立高危因素.乳腺癌患者发生LRR后,应积极行局部手术及放射治疗以降低远处转移的风险.

Objective To investigate the prognostic factors affecting survival outcome for locoregional recurrence in postmastectomy of breast cancer.Methods A retrospective study was performed on 61 breast cancer patients who suffering outcome of locoregional recurrence(LRR)treated by modified radical mastectomy.The clinical data of LRR patients with breast cancer and distant metastasis and clinical pathologic factors of survival were analyzed.Results Univariate analysis showed that triple-negative breast cancer,HER2-enriched breast cancer,time to LRR less than 2 years,no surgical removal of the lesions of LRR were correlated to survival outcome for LRR in postmastectomy of breast cancer.Multivariate analysis revealed that triple-negative breast cancer,HER2-enriched breast cancer,no surgical removal of the lesions of LRR were independent risk factors influencing risk of distant metastasis for LRR in postmastectomy of breast cancer.Among them,the risks of distant metastasis of triple-negative breast cancer,HER2-enriched breast cancer after LRR are 3.58 times and 2.87 times more than Luminal A/B(HER2-negative)breast cancer.In addition,triple-negative breast cancer,HER2-enriched breast cancer were independent risk factors influencing overall survival after LRR,their risk of death were 3.886 times and 3.097 times more than Luminal A/B(HER2-negative)breast cancer.Conclusion LRR of breast cancer after mastectomy correlates with a high risk of distant metastasis events and death in particular in patients with triple-negative and HER2-enriched breast cancer.Radiotherapy and mastectomy for LRR are warranted to reduce the risk of distant metastasis.