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目的 探讨乳腺癌保留乳腺手术后局部复发及远处转移的相关因素。 方法 回顾性分析保乳治疗原发性女性乳腺癌 174例 ,随访 12～ 196个月 ,随访率 97 13% ( 16 9/ 174)。 结果局部复发9例 ,3年复发率 3 79% ( 5 / 132 ) ;远处转移 14例 ,5年转移率 10 99% ( 10 / 91) ;5年生存率92 31% ( 84/ 91)。保乳手术无放疗组 3年复发率 ( 12 12 % )显著高于手术加放疗组 ( 1 0 1% ) ,( χ2 =5 6 1,P <0 0 5 )。腋窝淋巴结阳性患者中保乳手术未化疗组 5年远处转移率 ( 44 4 4% )高于手术加化疗组 ( 6 6 7% ,P <0 0 5 )。切缘阳性与局部复发有关 (P <0 0 1)。乳腺癌诊断时年龄≤ 40岁、淋巴结阳性、组织学Ⅲ级与远处转移有关 (P <0 0 5 )。 结论 保乳术后应放疗 ;切缘阳性者应再切除至阴性或全乳切除术 ;年轻、淋巴结阳性、组织学分级Ⅲ级者应辅助化疗。
Objective To investigate the related factors of local recurrence and distant metastasis of breast cancer after breast surgery. Methods A retrospective analysis of breast conserving therapy for primary female breast cancer in 174 cases was followed up for 12 to 196 months. The follow-up rate was 97.13% (16/974). Results The local recurrence in 9 cases was 3 79% (5/132). The distant metastasis in 14 cases was 10 99% (10/91) in 5 years. The 5 year survival rate was 92 31% (84/91) . The 3-year recurrence rate (12 12%) in the no breast-conserving surgery group was significantly higher than that in the surgery plus radiotherapy group (χ2 = 561, P <0 05). The 5-year distant metastasis rate (44 4 4%) in the non-chemotherapy group was higher than that in the surgery plus chemotherapy group (65.7%, P 0 05) in patients with axillary lymph node positive breast-conserving surgery. Positive margins correlated with local recurrence (P <0.01). Breast cancer at diagnosis ≤ 40 years old, lymph node-positive, histological grade Ⅲ and distant metastasis (P <0 05). Conclusions After conservative operation, radiotherapy should be performed. Patients with positive margins should be resected to resection of negative or complete mastectomy. Young and lymph node positive histological grade Ⅲ should be adjuvant chemotherapy.