探究乳腺癌改良根治术后复发转移的危险因素。

回顾性选取2014年3月至2015年9月期间三家医院行乳腺癌改良根治术的155例乳腺癌患者临床资料，根据随访结果将其分为复发转移组49例和未复发转移组106例。采用统计软件包SPSS 22.0进行数据处理，术后复发转移单因素分析采用χ²检验，多因素分析采用Logistic回归模型进行分析。P<0.05为差异有统计学意义。

155例行乳腺癌改良根治术的患者术后肿瘤复发转移率为31.6%(49/155)，其中局部复发11例，远处转移38例。将单因素分析中与术后复发转移显著相关因素进行多因素分析，发现伴有脉管癌栓、原发肿瘤直径≥5 cm、腋淋巴结转移数目≥4枚、TNM分期为Ⅲ期、组织学分级Ⅲ级及激素受体(ER、PR)阴性是影响乳腺癌改良根治术后复发转移的独立危险因素(P<0.05)，而蒽环类联合紫衫类化疗、术后辅助放化疗及内分泌治疗是乳腺癌患者复发转移的保护因素(P<0.05)。

乳腺癌改良根治术后复发转移的独立危险因素包括脉管癌栓、原发肿瘤大小、腋淋巴结转移数目、TNM分期、组织学分级及激素受体状态等；针对以上因素制定综合的预防、治疗方案，能够降低复发转移风险，改善患者预后生存。

To explore the risk factors for recurrence and metastasis of breast cancer after modified radical mastectomy.

The clinical data of 155 breast cancer patients underwent modified radical mastectomy in three hospitals from March 2014 to September 2015 were analyzed retrospectively According to the follow-up results, there were 49 patients with recurrence and metastasis, while 106 patients with no recurrence and metastasis. Statistical analysis were performed by using SPSS22.0 software.The univariate analysis of postoperative recurrence and metastasis was performed by using χ² test, while Logistic regression model was used for multivariate analysis. A P value of<0.05 was considered as statistically significant difference.

The rate of tumor recurrence and metastasis was 31.6% (49/155) among the 155 patients underwent modified radical mastectomy, including 11 patients with local recurrence and 38 patients with distant metastasis. The factors in univariate analysis that were significantly associated with postoperative recurrence and metastasis were analyzed by Logistic regression. In terms of vascular cancer thrombus, primary tumor diameter of ≥5 cm, axillary lymph nodes metastasis of ≥4, TNM staging for Ⅲ, the histologic grading Ⅲ and negative hormone receptor (ER, PR) were considered as independent risk factors for recurrence and metastasis of breast cancer patients after modified radical mastectomy(P<0.05), while anthracycline combined with plethycline chemotherapy, postoperative adjuvant chemoradiotherapy and endocrine therapy were protective factors for recurrence and metastasis of breast cancer (P<0.05).

Independent risk factors for breast cancer recurrence and metastasis after modified radical mastectomy including vascular cancer thrombus, the diameter of primary tumor, the number of axillary lymph node metastasis, TNM staging, histological grade and hormone receptor status. A comprehensive prevention and therapeutic treatment based on the above factors might reduce the risk of recurrence and metastasis and could improve the patients’ prognosis.