Clinical Study Of Regional Lymphadenectomy For Postoperative Local Recurrence Of Breast Cancer

Objective:To explore the relationship between regional lymphadenectomy and postoperative local recurrence of stage p T_1²N₀M₀breast cancer patients,and to provide clinical evidence for accurate treatment of regional lymph nodes in patients with stage p T_1²N₀M₀breast cancer.Methods:A total of 232 female patients with stage p T_1²N₀M₀breast cancer who underwent surgery in the Department of Gastrointestinal and Breast surgery,the first affiliated Hospital of Shihezi University from August 1,2011 to December 31,2018 were collected.The patients in the study underwent mastectomy（breast conserving or total mastectomy）and regional lymphadenectomy（sentinel lymph node biopsy or axillary lymph node dissection）.According to the number of resected lymph nodes,the patients were divided into three groups:64 patients with less than 6 regional lymph nodes,70 patients with 6～10 regional lymph nodes and 98 patients with more than 10 regional lymph nodes.The factors mentioned in previous studies that may affect the local recurrence of breast cancer and regional lymphadenectomy were included in this study.The independent risk factors of postoperative local recurrence of breast cancer were obtained by univariate X²test and multivariate Logistic regression.After the independent risk factors were determined,232 patients were stratified according to the number of risk factors,the local recurrence rate of each group under the cumulative risk was obtained,and the differences between groups were analyzed.SPSS software for statistical analysis and drawing,P<0.05,the difference was statistically significant.Results:Local recurrence occurred in 16 cases of p T_1²N₀M₀breast cancer,including chest wall recurrence in 7 cases（43.75%）,axillary recurrence in 3 cases（18.75%）,supraclavicular lymph node recurrence in 6cases（37.50%）.There were no cases of internal breast lymph node recurrence and ipsilateral breast recurrence in this group.The total local recurrence rate was 6.9%.The 5-year overall survival rate of patients with local recurrence was 87.5%,and that of patients without local recurrence was 98.9%.There was a significant difference in overall survival rate between the two groups（OR=29.935,P<0.001,95%CI=7.921%～113.126%）.Univariate analysis showed that postoperative local recurrence in patients with stage p T_1²N₀M₀breast cancer was related to regional lymphadenectomy,progesterone receptor,endocrine therapy and vascular nerve cancer invasion.The results of multivariate analysis showed that regional lymphadenectomy and vascular nerve cancer invasion were independent risk factors for local recurrence in patients with stage p T_1²N₀M₀breast cancer.Finally,after stratified treatment of 232 patients,it was found that there were 120 patients in 0 risk groups,2 cases of local recurrence in 5 years,94 cases in 1 risk factor group with local recurrence rate of 1.7%in 5 years,8 cases in 1 risk factor group in 5 years,and 18 patients in 2 risk factor groups with local recurrence rate of 8.5%in 5 years.The local recurrence rate in 5 years was 27.8%.It shows that with the increase of the number of risk factors,the local recurrence rate of patients with stage p T_1²N₀M₀breast cancer increases significantly.Conclusion:1.The local recurrence rate of patients with stage p T_1²N₀M₀breast cancer was 6.9%.2.The chest wall is the most common site of postoperative local recurrence in patients with stage p T_1²N₀M₀breast cancer.3.Regional lymphadenectomy and vascular nerve cancer invasion are independent risk factors for postoperative local recurrence in patients with stage p T_1²N₀M₀breast cancer.4.With the increase of the number of independent risk factors,the local recurrence rate of patients with stage p T_1²N₀M₀breast cancer increased significantly.