The Analysis Of Postoperative Recurrence Factor And Prognostic Evaluation For Early Breast Cancer

Objective Discuss the clinical high-risk factor and construct recurrence prognosis model of postoperative recurrence about breast cancer, at the same time, explore the feasibility of early breast cancer conservative surgery by comparatively analyzing the effect of conservative surgery and mastectomy for early breast cancer.Methods This study retrospectively analysis 1720 patients with early breast cancer in our hospital from Oct.1995 to Dec 2008. The match was conducted according to four variables:age at diagnosis, the dimension of tumor, axillary lymph node status and pathological type. The match ratio was 1:1. The number of breast conservative therapy (BCT) and modified radical mastectomy (MRM) patients were both 860. Median follow-up time for the BCT group and MRM group were 41.5 and 39.5 months, respectively. The differences of incidence of loco-regional recurrence, disease free survival and overall survival at 5 years were compared. The characteristics of metastases and recurrence and the hazard curve of recurrence were also analyzed. Moreover the recurrent hazard model was established by logistic regression and was tested.Results There were no significant differences in incidence of loco-regional recurrence, disease free survival (DFS) and overall survival (OS) at 5 years between the two groups of patients. The incidence of loco-regional recurrence was 5.6% in MRM group and 7.8% in BCT group (P=0.126). The DFS in MRM and BCT patients were 90.1% and 89.6%(P=0.590); the OS in MRM and BCT patient were 99.3% and 97.9%(P=0.153). On univariate analysis, the axillary lymph node status and molecular type (MT) were obviously related to the loco-regional recurrent rate (P<0.05); tumor size,the axillary lymph node status,estrogen receptor(ER),molecular type and grade were obviously related to the DFS (P<0.05); tumor size,the axillary lymph node status,ER and molecular type were obviously related to OS (P<0.05). On multivariate analysis, the axillary lymph node status were obviously related to the loco-regional recurrent rate,DFS and OS (P<0.05). The postoperative recurrent hazard model was R=eL/(1+eL), and L=(-3.124)+(-1.034)*MT+ 0.569*Grade+0.547*Node. By validated, the prognostic model can accurately predict the risk of postoperative recurrence about breast cancer patients. Conclusion The ratio of breast conservative surgery in China is increasing in recent years. The axillary lymph nodes status was independent prognostic factor in univariate and multivariate analysis; By validated, the prognostic model can be used as a basis to determine the recurrence and guide clinical practice; For the early breast cancer patients, the breast conservative surgery not only can reduce the range of surgery and improve the life quality of the patients, but also get the same effect compared with modified radical mastectomy.