Factor analysis of diagnosis and surgical treatment of local regional recurrence in breast cancer patients
10.3760/cma.j.issn.0529-5815.2019.05.009
- VernacularTitle: 乳腺癌术后局部区域复发及再手术选择的相关因素分析
- Author:
Zeyu JIN
1
;
Yujie LU
;
Weiguo CHEN
;
Yafen LI
;
Xiaosong CHEN
;
Kunwei SHEN
Author Information
1. Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
- Publication Type:Journal Article
- Keywords:
Breast neoplasms;
Neoplasm recurrence, local;
Factor analysis, statistical
- From:
Chinese Journal of Surgery
2019;57(5):366-372
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the association between clinicopathological factors and clinical diagnosis, treatment and surgery of local regional recurrence (LRR) in breast cancer.
Methods:A retrospective study was done to evaluate consecutive 7 823 breast cancer LRR cases between January 2009 and August 2018 at Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine. A total of 108 LRR patients were enrolled: 35 cases (32.4%) with ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery, 40 cases (37.0%) of chest wall recurrence (CR), and 33 cases (30.6%) with regional lymph node recurrence (LNR). All patients were female, aged from 26 to 83 years with a mean of 49 years. Clinicopathological factor and its relationship with different sites of LRR and following surgical choice were analyzed by χ2 test, rank-sum test and Logistic regression. Survival analysis were performed between different LRR patterns and whether undergoing second surgery. Kaplan-Meier survival curves and Log-rank tests demonstrated the distribution of overall survival.
Results:Both univariate analysis and multivariate analysis found that axillary lymph nodes (ALN) status (OR=7.27, 95% CI: 1.30 to 40.53, P=0.042) and disease-free interval (OR=0.18, 95% CI: 0.06 to 0.60, P=0.013) were related to different site of LRR. Compared with patients with IBTR, LNR and CR patients had a higher rate of ALN metastasis and a shorter disease-free interval. A total of 36 LRR patients underwent following surgery. In univariate analysis, initial ALN surgery (χ2=16.705, P=0.001), pathological type (χ2=7.047, P=0.03), ALN status (χ2=10.812, P=0.002), disease-free interval (χ2=6.118, P=0.023) and LRR site(χ2=19.328, P=0.000) were associated with surgical treatment for LRR patients. Multivariate analysis demonstrated that only site of LRR was independently associated with surgery (OR=0.17, 95% CI: 0.05 to 0.65, P=0.024). The 5-year overall survival was 100% and 60.1% (P=0.018) for LRR patients treated with surgery or not. Furthermore, CR patients had significantly worse overall survival than LNR and IBTR patients, with 5-year overall survival 53.1%, 73.5%, and 100% respectively (P=0.021).
Conclusions:Initial lymph nodes metastasis and disease-free interval are associated with different site of LRR. LRR site significantly influenced following surgery choice after LRR, which are both related with overall survival after LRR.
