Clinical Prognostic Factors And Retreatment Analysis Of Postoperative Recurrence About Breast Cancer

Objective Discuss the clinical high-risk factor and constructs recurrence prognosis exponential model of postoperative recurrence about breast cancer, at the same time, comparative analysis the efficacy of recurrent patients with different treatment methods,for the postoperative recurrence forecast and retreatment provides the reference.Methods Clinical record of 91 cases of the postoperative recurrence about breast cancer in the Guangxi Medical college attached Tumour hospital from Janualy 1998 to October 2005 were review statistical analysis.Chooses the complete record 14 items in 91 cases to take the observational target,And analyzes the relations between these 14 clinical parameters and the postoperative recurrence about breast cancer by the COX risk model single factor and the multi-factor analysis,establish the prognosis exponential model and carry on the confirmation. Moreover,according to the different recurrent position,the patients of postoperative recurrence about breast cancer are divided into three groups including the local recurrence, the local recurrence with distant metastasis and the distant metastasis.And according to the different method of treatment, contrastively analyze the patient's survival rate among different methods in each group.Results1.The COX risk model single factor analysis result showed that menstrual situation,primary tumor size(diameter, partition diameter),clinical by stages,ER,Her-2,chemotherapy, radiotherapy,endocrine treatment as well as lymph node metastasis situation(lymph node masculine number,lymph node masculine number partition,the rate of lymph node metastasis) are obviously related to the postoperative recurrence about breast cancer(P<0.05).Age situation (age,partition age),tumour position,surgery way,lymph node cleaning situation(lymph node cleaning number,lymph node cleaning number partition) and PR aren't remarkablely related to the postoperative recurrence about breast cancer(P>0.05).2.The COX risk model multi-factor analysis result showed that clinical by stages,Her-2,ER,radiotherapy, chemotherapy and endocrine treatment are the independent prognosis factors(P<0.05).3.The prognosis index formula,PI=-1.224 +1.623*X₅ + 0.633*X₁₁– 0.478*X₉-0.829*X₁₂- 1.871*X₁₃ - 0.457*X₁₄,by validated, the prognostic index model can accurately predict the risk of postoperative recurrence about breast cancer patients.4.The patient's survival rate of local recurrence obviously surpasses the patient's survival rate of distant metastasis,the difference has statistics significance (P<0.05).But the difference between the patient's survival rate of distant metastasis and the patient's survival rate of local recurrence with distant metastasis has non-statistics significance(P=0.152).And the survival rate of patient's recurrence after two years surpasses it within two years,the difference has statistical significance(P=0.043).5.Patients with local recurrence, the median survival time of local treatment (or add systemic treatment / chemotherapy and(or) endocrine treatment) group was significantly higher than the untreated group and only the systemic treatment group, the difference has statistical significance(P<0.05).The difference between the survival time of untreated group and the systemic treatment group has no significant statistical significance(P=0.074).6.Patients with distant metastasis,the median survival time of systemic treatment supplemented with local treatment group was significantly higher than the systemic treatment group and the untreated group.In addition,the median survival time of systemic treatment group was also significantly higher than the untreated group. Three difference has statistical significance(P<0.05).7.Patients in Local recurrence with distant metastasis,the median survival time of the local palliative treatment with systemic treatment group and the systemic treatment group was significantly higher than the untreated or only Local treatment group(P<0.05).The median survival time of the local palliative treatment with systemic treatment group is 18 months,and the median survival time of systemic treatment group is 12 months,the median survival time of the former longer than the latter,but the difference has no statistical significance(P=0.051).Conclusions1.Primary tumor size, clinical by stages, Her-2 and lymph node metastasis situation are positively related to the postoperative recurrence of breast cancer ,and those are the risk factors.The rate of lymph node metastasis is better reflect the risk of recurrence than the number of positive lymph nodes.Menstrual situation,ER,postoperative radiotherapy, chemotherapy,endocrine therapy are negatively related to the postoperative recurrence of breast cancer,and those are protective factors. Moreover,clinical stage,Her-2,ER, postoperative radiotherapy, chemotherapy and endocrine therapy are reflected in the risk of breast cancer recurrence independent prognostic factors.The prognostic index formula:PI = -1.224+1.623*clinical stage+ 0.633*Her-2– 0.478*ER -0.829* chemotherapy - 1.871* radiotherapy - 0.457* endocrine therapy,by validated, this prognostic index can be used as a basis to determine and guide clinical practice.2.Local recurrence of breast cancer patients in the treatment should be based on local treatment (surgery and / or radiotherapy)and appropriate auxiliary to the systemic treatment. Patients with distant metastasis in the treatment should be mainly based on systemic therapy,if it can be supplemented by local treatment of metastases, curative effect is better.Local recurrence with distant metastasis in patients with local palliative treatment add systemic treatment can significantly improve the quality of life of patients and achieve better curative effect.