| Objective:At present,the mode of local recurrence(LRR)after breast cancer surgery has changed,and there is no consensus on the treatment plan.This study is aim to compare the clinical pathological features of the different LRR location through the retrospective analysis on the clinical data of postoperative breast cancer patients with LRR,to investigate the relationship between the LRR location and prognosis of breast cancer and evaluate its effect on the LRR the prognosis of breast cancer patients,in order to provide thinking for comprehensive diagnosis and treatment of surgical treatment strategies of postoperative breast cancer patients with LRR.Methods:From January 2010 to December 2016,96 breast cancer patients who had received surgical treatment in the Breast Surgery Department of The First Affiliated Hospital of Nanchang University and Wusong Center Hospital of Shanghai were selected.According to the LRR location during follow-up after surgical treatment,the patients were divided into three groups:ipilateral breast tumor recurrence(IBTR)group was refers to recurrence of ipsilateral breast tumor with or without regional lymph node metastasis after breast-conserving surgery,chestwall recurrence(CR)group refers to recurrence of the chestwall after surgery,with or without regional lymph node metastasis;regional lymph node recurrence(LNR)group refers to ipsilateral axillary lymph node(ALN),subclavicular lymph node,supraclavicular lymph node,internal breast lymph node and/or interpectoral lymph node recurrence.The study design was in line with the Helsinki Declaration of the World Medical Association,and all patients or close relatives signed the informed consent.Through the hospital medical records system,clinical data including general data such as age,body mass index,body mass index(BMI),menstrual status,and clinical pathological characteristics such as the pathological type,tumor size,lymph node status,treatment regimen(surgery,chemotherapy,radiotherapy)after recurrencewere collected,and expression of the human epidermal growth factor receptor 2(HER-2),estrogen receptor(ER),progesterone receptor(PR)of primary tumor lesion were detected.The short-term efficacy was evaluated according to the version 1.1 of the solid tumor efficacy evaluation standard,and the long-term efficacy was evaluated under follow-up until June 2020.The clinical efficacy and overall survival(OS)of ITBR group,CR group and LNR group were compared,and the factors affecting the prognosis of LRR patients were analyzed by logistics regression.Excel 2010 was used to input the research data,and SPSS 20.0 software was used for statistical analysis.Qualitative data were expressed in terms of frequency and percentage,and comparison between groups was made by chi-square test.The effect of LRR on prognosis was analyzed by multivariate Logistic regression.Kaplan-Meier survival analysis was used to analyze the correlation between LRR locations and OS,and P<0.05 was considered statistically significant.Results:1.There were no statistically significant differences in age,menstrual state,BMI,tumor diameter,pathological stage,lymphatic metastasis,surgical method of primary tumor,HER-2,PR,ER and other molecular indicators among ITBR,CR,and LNR groups(P>0.05).LRR location was significantly correlated with pathological type and surgical mode after recurrence(P<0.05),but not significantly correlated with adjuvant chemotherapy and radiotherapy(P>0.05).2.All the 96 LRR patients received treatment,including 61 patients with surgery,73 patients with chemotherapy and 78 patients with radiotherapy.The ORR of CR group was 28.57%,which was significantly lower than that of ITBR group(54.55%)(P<0.05).There was no significant difference in ORR between the other groups(P>0.05).3.There was statistically significant difference between the death group and the survival group in terms of pathological type,pathological stage,LRR,lymphatic metastasis,treatment mode(surgery,chemotherapy,radiotherapy)after recurrence and the expression of ER,PR,HER-2(P<0.05).Comparison of other indicators between the two groups showed no statistically significant difference(P>0.05).4.With prognosis as the dependent variable,significant variables of univariate analysis were included in stepwise logistic regression analysis.Multiple logistic regression analysis showed that pathological stage,HER-2(positive)and LRR(CR)were independent risk factors for prognosis of patients with local recurrence after breast cancer surgery(P<0.05),while surgery after LRR was independent protective factor for prognosis(P<0.05).5.Kaplan-Meier survival curve analysis showed that the median OS in LRR patients was 44.77 months(95%CI:41.57～47.96),the median OS of patients with different LRR location was from high to low 50.76 months in ITBR group(95%CI:46.91～54.61)>41.58 months in LNR group(95%CI:37.81～45.34)>33.28 months in CR group(95%CI:29.84～36.71)(χ~2=15.10,P<0.05).Conclusions:1.LRR locations of Postoperative breast cancer patients are significantly correlated with pathological types and surgical methods after recurrence.Most CR and LNR patients are invasive ductal carcinoma,and the proportion of surgical treatment after recurrence is relatively low,while ITBR patients have a large proportion of ductal carcinoma in situ and surgery treatment,and with relatively early stage of disease.2.LRR locations after breast cancer surgery is closely related to prognosis,and ITBR patients has relatively good retreatment effect and prognosis,However,there are also potentially curable subgroups in LNR and CR patients.Active surgical resection of recurrent lesions is of great significance to prolong survival and improve prognosis of LRR patients with breast cancer. |
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