探究首诊Ⅳ期乳腺癌手术患者首诊及术后临床病理特征，转移和治疗情况，旨在探讨其对预后的影响。

回顾性分析2007年2月至2017年12月两家医院收治的266例首诊Ⅳ期乳腺癌原发灶手术患者的临床病例资料。随访起始时间为患者确诊时间，随访截止时间为患者死亡时间或2020年12月31日。纳入年龄、主诉时间、首诊临床T/N分期、转移情况、术后分子标志物表达、手术时机、术后切缘、脉管癌栓情况、术后病理T/N分期及治疗情况，研究手术患者的预后相关因素。应用Stata 15.0软件进行统计学分析，预后的单变量分析采用Log-Rank检验，预后的多变量分析采用Cox回归模型分析。P<0.05为差异有统计学意义。

预后单因素分析：临床N分期，首诊转移情况，术后ER、PR表达情况，术后 Ki-67 表达水平，术后切缘情况，术后病理 T、N分期和术后原发灶区域放疗与患者的OS相关（P 值均<0.05）。预后多因素分析：首诊转移情况，术后 Ki-67 表达水平，术后病理 T、N 分期和术后原发灶区域放疗均是影响患者 OS 的独立预后因素（P 值均<0.05）。

患者术后病理 T、N 分期低，首诊寡转移状态稳定，术后 Ki-67≤20%，术后原发灶区域放疗生存更能获益。

To investigate the clinicopathological features, metastasis and treatment of patients undergoing first diagnosis and postoperative surgery for stage Ⅳ breast cancer, and to explore the influence on prognosis.

The clinical data of 266 patients with stage Ⅳ primary breast cancer undergoing surgery for the first time admitted to two hospitals from February 2007 to December 2017 were retrospectively analyzed. Follow-up started at the time of diagnosis and ended at the time of death or December 31, 2020. Age, chief complaint time, first clinical T/N stage, metastasis, postoperative molecular marker expression, operation time, postoperative resection margin, vascular cancer embolus, postoperative pathological T/N stage and treatment were included to study the prognostic factors of patients undergoing surgery. Stata 15.0 software was used for statistical analysis. Log-Rank test was used for univariate analysis of prognosis, and Cox regression model was used for multivariate analysis of prognosis. P<0.05 was considered statistically significant.

Univariate analysis of prognosis: clinical N stage, first diagnosis metastasis, postoperative ER and PR expression, postoperative Ki-67 expression level, postoperative resection margin, postoperative pathological T and N stage and postoperative primary site radiotherapy were correlated with patients' OS (P<0.05). Multivariate analysis of prognosis: The first diagnosis of metastasis, the expression level of Ki-67 after surgery, the T and N stages of postoperative pathology, and the radiotherapy of the primary site were all independent prognostic factors affecting the patients' OS (P<0.05).

The postoperative pathological T and N stages of the patient were low, the oligometastases were stable at the first diagnosis, and the postoperative Ki-67 was less than 20%. The survival of the patient with radiotherapy in the primary site was more beneficial.