目的 探讨乳腺癌术后患者不同局部区域复发（local regional recurrence,LRR）对预后的影响。方法 回顾性分析2010年1月—2016年12月期间在南昌大学第一附属医院,上海市吴淞中心医院乳腺外科接受手术治疗的96例乳腺癌患者。根据LRR发生部位,将患者分为同侧乳房肿瘤复发（ipilateral breast tumor recurrence,IBTR）组（n=33）、胸壁复发（chestwall recurrence,CR）组（n=35）、区域淋巴结复发（lymph node recurrence,LNR）组（n=28）,比较各组的临床疗效、总生存时间（OS）,采用logistic回归分析乳腺癌术后LRR患者预后的影响因素。结果 CR组客观缓解率（Objective remission rate, ORR）为28.57%,显著低于ITBR组的54.55%（P<0.05）。死亡组与存活组在病理类型、病理分期、LRR、淋巴转移、复发后治疗方式（手术、化疗、放疗）及ER、PR、HER-2表达方面进行比较,差异有统计学意义（P<0.05）。多因素logistic回归分析显示,病理分期、HER-2（阳性）、LRR（CR）是影响乳腺癌术后LRR患者预后的独立危险因素（P<0.05）,而LRR后手术则是预后的独立保护因素（P<0.05）。Kaplan-Meier生存曲线分析显示,不同LRR部位患者中位OS由高到低依次为ITBR组50.76个月（95%CI：46.91~54.61）、LNR组41.58个月（95%CI：37.81~45.34）和CR组33.28个月（95%CI：29.84~36.71）（χ²=15.10,P<0.05）。结论 乳腺癌术后LRR部位与预后密切相关,ITBR的治疗效果及预后相对较好,积极地行复发病灶手术切除对于乳腺癌LRR患者延长生存期、改善预后具有重要意义。

Objective To evaluate the influences of different local regional recurrence （LRR） on prognosis of breast cancer patients after surgery. Methods The clinical data of 96 patients with breast cancer who received surgical treatment in the departments of breast surgery of the First Affiliated Hospital of Nanchang University and of Shanghai Wusong Hospital from January 2010 to December 2016 were analyzed retrospectively. According to the location of LRR, the patients were divided into three groups： ipilateral breast tumor recurrence （IBTR） group （n=33）, chestwall recurrence （CR） group （n=35）, and regional lymph node recurrence （LNR） group （n=28）. The clinical efficacy and overall survival （OS） of the two groups were compared, and the factors affecting the prognosis of LRR patients were analyzed by logistic regression. Results The objective remission rate of the CR group was 28.57%, significantly lower than that of the ITBR group （54.55%, P<0.05）. There were significant differences between the death group and the survival group in terms of pathological type, pathological stage, LRR, lymphatic metastasis, treatment mode （surgery, chemotherapy, and radiotherapy） after recurrence, and the expressions of ER, PR, and HER-2 （P<0.05）. Multiple logistic regression analysis results showed that pathological stage, HER-2 （positive）, and LRR （CR） were independent risk factors for prognosis of LRR patients with local recurrence after breast cancer surgery （P<0.05）, while surgery after LRR was an independent protective factor for prognosis （P<0.05）. Kaplan-Meier survival curve analysis results showed that the median OS of patients with different LRR locations from high to low were 50.76 months in the ITBR group （95% CI： 46.91-54.61）, 41.58 months in the LNR group （95% CI： 37.81-45.34）, and 33.28 months in the CR group （95% CI： 29.84-36.71） （χ²=15.10, P<0.05）. Conclusion LRR locations of postoperative breast cancer are closely related to prognosis, and ITBR shows a better therapeutic effect and prognosis. Active surgical resection of recurrent lesions is of great significance to prolong survival and improve prognosis of breast cancer patients with LRR.