乳腺导管内癌患者手术方式选择及预后分析

摘要

To explore the selection of surgical methods of breast ductal carcinoma (DCIS) and its influencing factors,and the effect of different surgical methods on prognosis of patients were compared.Retrospective analysis of 253 cases of DCIS patients who underwent surgical treatment in our hospital from Mar.2008 to Jun.2012,to collect the clinical data of patients,the factors influencing the selection of surgical methods of patients with DCIS were analyzed by single factor and Logistic regression analysis,and the effect of different surgical methods on patients' prognosis was compared with kaplanmeier method and log-rank examination.There were 175 cases (69.17％) of total mastectomy in 253 patients,and 78 cases (30.83％) were received with the retention of mastectomy,of which 56 patients (22.13％) received radiotherapy after surgery.The independent factors that affect the selection of surgical methods of patients with DCIS are the age≥55 years (OR=0.029,95％CI:0.009～0.091,P=0.000),the first symptoms are eczema of the nipple (OR=8.319,95％ CI:2.229～31.045,P=0.002),biopsy is performed in a biopsy (OR=3.155,95％CI:1.496～6.776,P=0.003),the pathological tissue type is acne (OR=11.287,95％CI:4.015～31.734,P=0.000),the largest diameter of the tumor is ＞3cm (OR=8.362,95％CI:2.741～25.514,P=0.000);There was no statistically significant difference in 5 years of disease-free survival rate and 5 years of total survival rate between the total mastectomy,reserving mastectomy combined with radiotherapy,and mastectomy groups (P＞0.05).Age,starting symptoms,biopsy,histopathologic type and the largest diameter of the tumor are the main factors influencing the DCIS patients' operation method choice,and treated with different ways of operation of the disease-free survival and overall survival in patients with no significant difference.%探讨乳腺导管内癌(DCIS)患者手术方式的选择及其影响因素,并比较不同手术方式对患者预后的影响.回顾性分析2008年3月～2012年6月于笔者所在医院进行手术治疗且符合纳入标准的DCIS患者253例,收集患者临床资料,采用单因素和Logistic回归分析影响DCIS患者手术方式选择的因素,采用Kaplan-Meier法和Log-rank检验比较不同手术方式对患者预后的影响.253例患者中接受全乳切除术175例(69.17％),接受保乳术78例(30.83％),其中56例(22.13％)患者保乳术后接受了放疗;年龄≥55岁(OR=0.029,95％CI:0.009～0.091,P=0.000)、首发症状为乳头湿疹(OR=8.319,95％CI:2.229～31.045,P=0.002)、活检方式为切除活检(OR=3.155,95％CI:1.496～6.776,P=0.003)、病理类型为粉刺型(OR=11.287,95％CI:4.015～31.734,P=0.000)、瘤体最大径＞3cm(OR=8.362,95％CI:2.741～25.514,P=0.000)为影响DCIS患者手术方式独立因素;全乳切除术、保乳术联合放疗、单纯保留乳房术三组之间的5年无病生存率、5年总生存率比较,差异均无统计学意义(P＞0.05).年龄、首发症状、活检方式、病理类型、瘤体最大径是影响DCIS患者手术方式选择的主要因素,且不同手术方式患者无病生存率和总生存率差异无统计学意义.