浸润性乳腺癌(T_(1-2)N_(0)M_(0)期)SLNB阴性患者保腋窝术后预后的相关因素分析  

The clinical analysis of prognosis influencing factors of patients with negative sentinel lymph node biopsy in the invasive breast cancer with T_(1-2)N_(0)M_(0)期after axillary sparing surgery

作　　者：游紫萱 陈红[1] 肖丽[1] 马璐 但凤英 郑晓筱 You Zixuan;Chen Hong;Xiao Li;Ma Lu;Dan Fengying;Zheng Xiaoxiao(Department of Breast Surgery,Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610072,China)

机构地区：[1]成都中医药大学附属医院乳腺外科,成都610072

出　　处：《中华普外科手术学杂志（电子版）》2021年第6期617-620,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：四川省中医药科学技术研究专项项目(2016C038);四川省卫生健康委员会科研课题(19ZD019)。

摘　　要：目的探究影响T_(1-2)N_(0)M_(0)期浸润性乳腺癌前哨淋巴结活检(SLNB)阴性行保腋窝术(APS)患者预后的相关因素。方法回顾性分析2014年1月至2016年8月行APS术的115例T_(1-2)N_(0)M_(0)期浸润性乳腺癌SLNB阴性患者资料。采用统计学软件SPSS 22.0进行数据处理,复发、转移例数等计数资料使用[例(%)]表示,单因素生存分析采用K-M法,行Log-rankχ^(2)检验;Cox回归模型进行预后多因素分析,P<0.05为差异有统计学意义。结果115例患者均获得随访,时间27~49个月,中位随访时间为37个月,术后3例出现局部复发,2例出现区域复发,3例出现骨、胸膜转移,总复发转移率为7.0%(8/115),术后无病生存率为93.0%(107/115)。单因素分析显示,SLN检出数、肿瘤最大径、病理类型、组织学分级、脉管浸润及术后辅助治疗是影响患者预后无病生存率的危险因素(P<0.05)。Cox回归多因素分析显示,脉管浸润是影响患者预后无病生存的独立危险因素[HR(95%CI):2.213(1.567~4.201),P=0.005],术后辅助治疗是预后无病生存的保护因素[HR(95%CI):0.759(0.473~0.914),P=0.042]。结论伴随有脉管浸润会增加T_(1-2)N_(0)M_(0)期浸润性乳腺癌前哨淋巴结阴性患者术后复发的风险,是影响患者预后无病生存的独立危险因素。Objective To explore the prognosis influencing factors of patients with negative sentinel lymph node biopsy(SLNB)in the invasive breast cancer of T_(1-2)N_(0)M_(0)期after axillary sparing surgery(APS).Methods The clinical data of 115 patients with negative SLNB invasive breast cancer of T_(1-2)N_(0)M_(0)期who underwent APS from January 2014 to August 2016 were analyzed retrospectively.Statistical analysis were performed by using SPSS 22.0 software.The number of recurrent and metastatic cases were expressed as[case(%)].Univariate survival analysis were performed by using K-M method and were examined by using Log-rankχ^(2) test.Cox regression model was used for multivariate analysis of prognosis.A P value of<0.05 was considered as statistically significant difference.Results All of the 115 patients were followed up for 27 to 49 months,with a median follow-up time of 37 months.There were 3 cases of local recurrence,2 cases of regional recurrence and 3 cases of bone or pleural metastasis.The overall recurrence and metastasis rate was 7.0%(8/115)with disease-free survival rate of 93.0%(107/115).The Univariate analysis showed that SLN detection number,maximum tumor diameter,pathological type,histological grade,vascular infiltration and postoperative adjuvant therapy were the risk factors affecting the disease-free survival rate(P<0.05).Cox regression multivariate analysis showed that vascular infiltration was the independent risk factor for disease-free survival[HR(95%CI):2.213(1.567`4.201),P=0.005],with the postoperative adjuvant therapy as a protective factor for disease-free survival[HR(95%CI):0.759(0.473-0.914),P=0.042].Conclusion Concomitant vascular infiltration is an independent risk factor for disease-free survival of patients with invasive breast cancer of T_(1-2)N_(0)M_(0)期with negative sentinel lymph nodes,which could increase the risk of postoperative recurrence.

关 键 词：乳腺肿瘤 哨淋巴结活组织检查 保腋窝术 预后 

分 类 号：R73[医药卫生—肿瘤]