Objective: To investigate the clinicopathologic features and prognostic factors of breast cancer patients with tumor deposits in the ipsilateral axillary region. Methods: We retrospectively analyzed the clinicopathologic data and follow-up results of 155 patients with breast cancer diagnosed for the first time and complicated with tumor deposits in the ipsilateral axillary region in the Department of Thyroid-Breast-Vascular Surgery of Xijing Hospital from January 2008 to September 2018. Kaplan-Meier method was used for survival analysis. Log rank test was used for the univariate analysis of prognostic factors, and Cox regression was used for multivariate analysis. Results: The median disease free survival (DFS), median distant metastasis free survival (DMFS), and median overall survival (OS) of the 155 patients were 52.0 months, 66.6 months, and 102.2 months, respectively. The 5-year and 10-year DFS rates were 45.7% and 23.1%, the 5-year and 10-year DMFS rates were 56.9% and 28.9%, and the 5-year and 10-year OS rates were 79.3% and 46.0%, respectively. Multivariate Cox regression analysis showed that family tumor history (HR=0.362, 95% CI: 0.140-0.937), clinical T stage (T3: HR=3.508, 95% CI: 1.380-8.918; T4: HR=2.220, 95% CI: 1.076-4.580), estrogen/progesterone receptor status (HR=0.476, 95% CI: 0.261-0.866), number of tumor deposits (HR=1.965, 95% CI:1.104-3.500) and neoadjuvant chemotherapy (HR=1.961, 95% CI: 1.032-3.725) were independent influencing factors for DFS. Molecular subtype [human epidermal growth factor receptor-2(HER-2) positive and hormone receptor negative: HR=7.862, 95% CI: 3.189-19.379], number of tumor deposits (HR=2.155, 95% CI: 1.103-4.212), neoadjuvant chemotherapy (HR=5.002, 95% CI: 2.300-10.880) and radiotherapy (HR=2.316, 95% CI: 1.005-5.341) were independent influencing factors of DMFS. Histological grade (HR=4.362, 95% CI: 1.932-9.849), estrogen/progesterone receptor expression (HR=0.399, 95% CI: 0.168-0.945), HER-2 expression (HR=2.535, 95% CI: 1.114-5.768) and neoadjuvant chemotherapy (HR=4.080, 95% CI: 1.679-9.913) were independent influencing factors of OS. Conclusions: The presence of tumor deposits weakens the influence of axillary lymph node status and distant metastases on the prognosis of breast cancer patients. Therefore, a clinicopathological staging system taking into account tumor deposits should be developed. Since the number of tumor deposits affects the risk of recurrence and metastasis of breast cancer patients, we recommend that the number of tumor deposits should be reported in detail in the pathological report after breast cancer surgery.
目的： 探讨合并患侧腋窝癌结节乳腺癌患者的临床病理特点及预后影响因素。 方法： 分析2008年1月至2018年9月在西京医院甲状腺乳腺血管外科初次确诊乳腺癌且合并患侧腋窝癌结节的155例乳腺癌患者的临床及随访资料，采用Kaplan-Meier法进行生存分析，预后影响因素的单因素分析采用Log rank检验，多因素分析采用Cox回归分析。 结果： 155例患者患者的中位无病生存时间（DFS）为52.0个月，中位无远处转移生存时间（DMFS）为66.6个月，中位总生存时间（OS）为102.2个月。5年和10年无复发转移生存率分别为45.7%和23.1%，5年和10年无远处转移生存率分别为56.9%和28.9%，5年和10年总生存率分别为79.3%和46.0%。多因素Cox回归分析显示，家族肿瘤病史（HR=0.362，95% CI：0.140～0.937）、临床T分期（T3期：HR=3.508，95% CI：1.380～8.918；T4期：HR=2.220，95% CI：1.076～4.580）、雌/孕激素受体状态（HR=0.476，95% CI：0.261～0.866）、癌结节数量（HR=1.965，95% CI：1.104～3.500）以及是否新辅助化疗（HR=1.961，95% CI：1.032～3.725）是患者DFS的独立影响因素，分子分型［表皮生长因子受体2（HER-2）阳性激素受体阴性：HR=7.862，95% CI：3.189～19.379］、癌结节数量（HR=2.155，95% CI：1.103～4.212）、是否新辅助化疗（HR=5.002，95% CI：2.300～10.880）以及放疗（HR=2.316，95% CI：1.005～5.341）是患者DMFS的独立影响因素，组织学分级（HR=4.362，95% CI：1.932～9.849）、雌/孕激素受体表达（HR=0.399，95% CI：0.168～0.945）、HER-2表达（HR=2.535，95% CI：1.114～5.768）以及是否新辅助化疗（HR=4.080，95% CI：1.679～9.913）是患者OS的独立影响因素。 结论： 癌结节的存在削弱了腋窝淋巴结状态和是否有远处转移对乳腺癌患者预后的影响，应制定将癌结节考虑在内的乳腺癌临床病理分期系统。癌结节数量影响乳腺癌患者的复发转移风险，建议在乳腺癌术后病理报告中详细报告检出的癌结节数量。.