游离真皮脂肪瓣保留乳房术与传统保留乳房术的预后影响因素分析  

Comparison of prognostic factors between free dermal fat flap breast-conserving surgery and traditional breast-conserving surgery in patients with breast cancer

作　　者：黄佳鹏[1] 庄亚强[1] 周韬[1] 曹一鸣[1] 韦德飞 石青梅 HUANG Jia-peng;ZHUANG Ya-qiang;ZHOU Tao;CAO Yi-ming;WEI De-fei;SHI Qing-mei(Second Department of Breast and Thyroid Surgery,Liuzhou Peoples Hospital,Liuzhou 545006,China)

机构地区：[1]柳州市人民医院乳腺甲状腺外科二病区,广西柳州545006

出　　处：《中华肿瘤防治杂志》2021年第9期676-681,687,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20190012)。

摘　　要：目的比较游离真皮脂肪瓣保留乳房术与传统保留乳房术对乳腺癌患者预后的影响,并分析影响患者预后的风险因素。方法回顾性分析柳州市人民医院2015-06-01-2020-09-30收治的120例接受保留乳房术乳腺癌患者临床病理资料及随访结果,依据手术方式分为游离真皮脂肪瓣保留乳房术组(50例)及传统保留乳房术组(70例),对2组临床病例特征行χ^(2)检验,采用Kaplan-Meier分析比较2组的局部复发率、无瘤生存率和总生存率,采用才检验及Cox回归分析明确影响患者预后的因素。结果所有病例随访4〜63个月,中位时间42个月。2组患者在年龄、淋巴结状态、肿瘤大小、组织学分级、临床分期、HER2状态及ER/PR状态方面差异无统计学意义,均P>0.05。真皮脂肪瓣组局部复发3例,远处转移8例,死亡4例3年无瘤生存率为86.0%,5年无瘤生存率为78.0%,总生存率为94.0%;传统保留乳房术组局部复发2例,远处转移11例,死亡5例,3年无瘤生存率为91.4%,5年无瘤生存率为81.4%,总生存率为94.3%,2组比较均差异无统计学意义,均P>0.05。单因素分析显示,腋窝淋巴结(χ^(2)=14.903,P<0.001)、ER/ER(χ^(2)=21.888,P<0.001)及HER2(χ^(2)=7.070,P=0.008)状态与无病生存率关联;多因素分析显示,腋窝淋巴结阴性(HR=4.932,95%CI为1.453〜16.749,P=0.011)及ER/ER阳性(HR=O.126,95%CI为0.039-0.403,P<0.001)是延长患者无病生存期的独立预后因素。结论游离真皮脂肪瓣保留乳房术安全可靠,可提高保留乳房率,腋窝淋巴结及ER/PR状态是影响预后的主要因素。Objective To compare the effects of breast conserving surgery(BCS)with free dermal fat graft(FDFG)and traditional breast conserving surgery(TBCS)on the prognosis of breast cancer patients,and to analyze the risk factors affecting the prognosis of patients.Methods The clinicopathologic data of the patients who had undergone BCS(120 cases)in Liuzhou Peoples Hospital,during June 1st,2015 and September 30th,2020,was retrospectively analyzed.The patients was divided into FDFG group(50 cases)and TBCS group(70 cases)depending on surgical procedure.Clinicopathologic data of two groups were compared by chi-square test,Kaplan-meier analysis was used to compare the local recurrence(LR)rate,disease-free survival(DFS)rate and overall survival(OS)rate of the two groups.Chi-square test and Logistic regression analysis was used to analyze the factors affecting the prognosis of patients.Results All patients were followed up for 4-63 months,with a median of 42.There were no statistical differences in age,lymph node status,tumor size,histological grade,clinical stage,HER2 status and ER/PR status between the two groups(all P>0.05).In the FDFG group,LR occurred in 3 cases,distant metastasis in 8 cases and death in 4 cases.The 3-year DFS rate was 86.0%,the 5-year DFS rate was 78.0%,and the OS rate was 94.0%.In the TBCS group,LR occurred in 2 cases,distant metastasis in 11 cases and death in 5 cases.The 3-year DFS rate was 91.4%,the 5-year DFS rate was 81.4%,and the OS rate was 94.3%.There were no statistical differences between the two groups(P>0.05).The analysis of prognostic correlation factors in patients of FDFG group show that axillary lymph node,ER/PR and HER2 status correlated to the DFS rates(P<C0.05).Univariate analysis showed that axillary lymph node(χ^(2)=14.903,P=0.000),ER/ER(χ^(2)=21.888,P=0.000)and HER2(χ^(2)=7.070,P=0.008)status were correlated with DFS rate.Multivariate analysis showed that axillary lymph node(HR=4.932,95%CI:1.453-16.749,P=0.O11)and ER/ER(H R=0.126,95%CI:0.039-0.403,P=0.000)status were independent f

关 键 词：乳腺肿瘤 外科皮瓣 真皮 脂肪组织 乳房成形术 

分 类 号：R737.9[医药卫生—肿瘤]