乳腺癌保乳治疗后局部复发的临床研究  

The clinical research of local recurrence after breast-conserving therapy for breast cancer

作　　者：王立泽[1] 欧阳涛[1] 王天峰[1] 解云涛[1] 范照青[1] 范铁[1] 林本耀[1] 李金锋[1] 

机构地区：[1]北京大学临床肿瘤学院北京肿瘤医院暨北京市肿瘤防治研究所,恶性肿瘤发病机制及转化研究教育部重点实验室乳腺癌预防治疗中心,100142

出　　处：《中华外科杂志》2010年第24期1851-1854,共4页Chinese Journal of Surgery

摘　　要：目的 比较分析乳腺癌保乳治疗后局部复发病例与同期非复发病例资料,分析影响局部复发的风险因素.方法 密切随访2000年1月至2008年6月收治的1034例保乳治疗患者.患者年龄23～94岁,中位年龄48岁.分析年龄、雌激素受体（ER）/孕激素受体（PR）状态、人类表皮生长因子受体2（HER-2）状态、淋巴结转移状态、肿瘤大小、新辅助化疗、病理类型对局部复发的影响.结果 随访截至2010年6月,中位随访42个月（3～126个月）,同侧乳房局部复发35例（3.3%）,远位转移47例（4.5%）,5年无病生存率87.7%,5年无远处转移生存率94.0%,5年总体生存率99.3%.单因素分析显示,淋巴结状态、年龄及HER-2表达状态是影响局部复发的风险因素;复发高峰时间为术后第2年至第3年,以及第5年至第6年;多因素分析显示HER-2状态是局部复发的独立影响因素.结论 保乳治疗后出现两个局部复发高峰时间段,HER-2表达状态是局部复发的独立影响因素,对于具有高危因素的患者需更积极治疗.Objective To compare and analyze the data of breast caner recurrence after breastconserving therapy （ BCT）, and to find high risk factors that can affect local recurrence. Methods A total of 1034 patients in the data base between January 2000 and June 2008 were analyzed retrospectively. The patients aged 23 to 94 years when diagnosed （ median age, 48 years）. The data was investigated to compare of two different groups in local recurrence rate and survival rate. The high risk factors of recurrence after BCT [estrogen receptor （ ER ）/progesterone receptor （ PR ）, human epidermal growth factor receptor （ HER-2 ）,age, lymph node involvement, tumor diameter, neoadjuvant chemotherapy, pathological status] were studied. Results The patients were followed-up to June 2010, and the median period was 42 months （range, 3-126 months）. During the period, 35 patients developed ipsilateral breast tumor recurrence （3.3%）, 47 patients had metastasis to distant organs （4.5%）. The 5-year disease-free survival was 87. 7%, 5-year distant disease-free survival was 94. 0%. The lymph node status, HER-2 status and age were significant risk factors for ipsilateral breast tumor recurrence on univariate analysis. One peak recurrence period was from the 2nd to 3rd year, and the other was from the 5th to 6th year after the operation. The HER-2 status was independent factors of ipsilateral breast tumor recurrence on multivariate analysis. Conclusions The recurrence happens primarily in the 2nd to 3rd and the 5th to 6th year after the breast-conserving therapy. HER-2 status is an independent factor of ipsilateral breast tumor recurrence. The patients with high risk factors of recurrence should be treated more aggressively.

关 键 词：乳腺肿瘤 复发 保乳治疗 危险因素 

分 类 号：R686[医药卫生—骨科学]