研究循环肿瘤细胞（CTCs）对伴1~3枚腋窝淋巴结（ALNs）阳性的T_1-2期乳腺癌患者预后的预测价值。

回顾性分析2016年1月至2019年12月符合标准的120例行腔镜乳腺癌改良根治术患者临床资料。采用SPSS 24.0统计学软件进行分析。通过COX风险回归模型进行患者预后单因素及多因素分析，绘制ROC曲线确定CTCs最佳临界值，使用Kaplan-Meier法绘制不同CTCs水平患者无病生存曲线，采用Log-rank检验分析生存率差异。以P<0.05为差异有统计学意义。

术后随访27~63个月，中位随访时间49个月。随访期间无患者死亡，共计10例患者发生局部复发，5例患者发生远处转移，其中1例患者为局部复发同时伴远处转移。患者5年无病生存率（DFS）为88.3%。COX单因素和多因素生存分析结果显示，年龄、pT2分期、分子分型三阴性及CTCs数值是患者术后预后的影响因素，也是独立影响因素（P<0.05）。CTCs的ROC曲线分析结果显示，AUC为0.807（95%CI：0.739-0.875），最佳临界值为3，约登指数为0.683，灵敏度为0.908，特异度为0.775。CTCs≥3组71例患者随访期间共发生复发转移10例，DFS为85.9%，CTCs<3组49例患者随访期间共发生复发转移4例，5年DFS为91.8%。两组DFS差异有统计学意义（χ²=4.006，P=0.045）。

CTCs对伴1~3枚ALNs阳性的T_1-2期乳腺癌患者的预后有一定的预测价值。当患者CTCs≥3个时，应结合年龄、pT分期、分子分型等其他临床病理特征考虑行术后放疗（PMRT）以改善患者预后。

To investigate the prognostic value of circulating tumor cells（CTCs）in patients with stage T_1-2 breast cancer with 1~3 positive axillary lymph nodes（ALNS）.

Clinical data of 120 patients with breast cancer who met the standards from January 2016 to December 2019 were retrospectively analyzed. SPSS24.0 statistical software. was used for analysis. Univariate and multivariate analysis of patient prognosis was performed by COX risk regression model. ROC curve is drawn to determine the optimal critical value of CTCS. Kaplan-Meier method was used to draw disease-free survival curves of patients with different CTCS levels，and log-rank test was used to analyze the difference in survival rates. P<0.05 was considered statistically significant.

The follow-up period was 27~63 months，with a median of 49 months. No patient died during the follow-up period，a total of 10 patients had local recurrence，5 patients had distant metastasis，and 1 of them had local recurrence with distant metastasis. The 5-year DFS was 88.3%.Cox univariate survival analysis showed that age，PT2 stage，triple negative molecular typing and CTCS number were the influential factors for postoperative prognosis（P<0.05）. ROC curve analysis of CTCS showed that the AUC was 0.807（95%CI：0.739-0.875），the optimal cut-off value was 3，the Youden index was 0.683，the sensitivity was 0.908，and the specificity was 0.775.During the follow-up period，10 of the 71 patients in the CTCS≥3 group had recurrence and metastasis，the 5-year disease-free survival rate was 85.9%，and 4 of the 49 patients in the CTCS<3 group had recurrence and metastasis，the 5-year DFS was 91.8%. The difference in DFS between the two groups was statistically significant（χ²=4.006，P=0.045）.

CTCS can predict the prognosis of breast cancer patients with stage T_1-2 and 1~3 p ALNs positive patients. When patients have CTCs≥3，PMRT should be considered in combination with other clinicopathological characteristics such as age，PT stage，molecular typing to improve the prognosis of patients.