摘要目的 探讨乳腺癌患者术后不同部位局部区域复发(LRR)及其后续术式选择的相关因素.方法 回顾性分析2009年1月至2018年8月在上海交通大学医学院附属瑞金医院乳腺疾病诊治中心接受乳腺癌手术治疗的连续7 823例患者中108例于随访期间发生LRR的患者的临床资料.患者均为女性,平均年龄49岁(范围:26～ 83岁).包括保留乳房术后同侧乳房肿瘤复发(IBTR)35例(32.4％)、胸壁复发(CR)40例(37.0％)、区域淋巴结复发(LNR)33例(30.6％).采用x2检验、秩和检验对临床资料进行比较,并用Logistic回归对乳腺癌临床病理特征与不同部位LRR及后续手术之间的关系进行多因素分析,采用Kaplan-Meier法绘制生存曲线,并用Log-rank法比较生存曲线间的差异,评估其是否会影响LRR乳腺癌患者的预后.结果 单因素及多因素分析结果显示,初始手术腋窝淋巴结有无转移(OR=7.27,95％CI:1.30～ 40.53,P=0.042)、术后无病间期(OR=0.18,95％CI:0.06～ 0.60,P=0.013)与LRR复发部位相关:相较于IBTR患者,LNR及CR患者初始腋窝淋巴结转移比例高,CR患者无病间期更短.共有36例患者接受后续手术治疗,单因素分析结果显示,复发后手术与初始淋巴结手术方式(x2=16.705,P=0.001)、原发灶病理类型(x2=7.047,P=0.030)、腋窝淋巴结有无转移(x2=10.812,P=0.002)、无病间期(x2=6.118,P=0.023)和LRR部位(x2=19.328,P=0.000)相关;多因素分析结果显示,只有LRR部位(OR=0.17,95％CI:0.05～ 0.65,P=0.024)是后续是否手术的独立相关因素.乳腺癌LRR患者接受手术治疗的5年总体生存率为100％,高于未接受手术治疗患者的60.1％(P=0.018);CR患者的预后劣于LNR和IBTR患者,5年生存率分别为51.8％、73.5％和100％(P=0.021).结论 初始淋巴结有无转移和无病间期与乳腺癌术后LRR的发生部位有关.乳腺癌术后LRR的部位与后续手术选择和患者的预后相关.

abstractsObjective To analyze the association between clinicopathological factors and clinical diagnosis,treatment and surgery of local regional recurrence (LRR) in breast cancer.Methods A retrospective study was done to evaluate consecutive 7 823 breast cancer LRR cases between January 2009 and August 2018 at Comprehensive Breast Health Center,Ruijin Hospital,Shanghai Jiaotong University School of Medicine.A total of 108 LRR patients were enrolled:35 cases (32.4％) with ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery,40 cases (37.0％) of chest wall recurrence (CR),and 33 cases (30.6％) with regional lymph node recurrence (LNR).All patients were female,aged from 26 to 83 years with a mean of 49 years.Clinicopathological factor and its relationship with different sites of LRR and following surgical choice were analyzed by x2 test,rank-sum test and Logistic regression.Survival analysis were performed between different LRR patterns and whether undergoing second surgery.Kaplan-Meier survival curves and Log-rank tests demonstrated the distribution of overall survival.Results Both univariate analysis and multivariate analysis found that axillary lymph nodes (ALN) status (OR=7.27,95％ CI:1.30 to 40.53,P=0.042) and disease-free interval (OR=0.18,95％ CI:0.06 to 0.60,P=0.013) were related to different site of LRR.Compared with patients with IBTR,LNR and CR patients had a higher rate of ALN metastasis and a shorter disease-free interval.A total of 36 LRR patients underwent following surgery.In univariate analysis,initial ALN surgery (x2=16.705,P=0.001),pathological type (x2=7.047,P=0.03),ALN status (x2=10.812,P=0.002),disease-free interval (x2=6.118,P=0.023) and LRR site(x2=19.328,P=0.000) were associated with surgical treatment for LRR patients.Multivariate analysis demonstrated that only site of LRR was independently associated with surgery (OR=0.17,95％ CI:0.05 to 0.65,P=0.024).The 5-year overall survival was 100％ and 60.1％ (P=0.018) for LRR patients treated with surgery or not.Furthermore,CR patients had significantly worse overall survival than LNR and IBTR patients,with 5-year overall survival 53.1％,73.5％,and 100％ respectively (P=0.021).Conclusions Initial lymph nodes metastasis and disease-free interval are associated with different site of LRR.LRR site significantly influenced following surgery choice after LRR,which are both related with overall survival after LRR.