PAM50基因突变与即刻乳房重建术治疗乳腺癌疗效的关系及对术后生存的预测

The relationship between PAM50 gene mutation and immediate breast reconstruction in the treatment of breast cancer and its prediction of postoperative survival

目的:研究PAM50基因突变与即刻乳房重建术治疗的乳腺癌患者疗效的关系及对患者术后生存期的预测价值。方法:选取2016年8月至2017年8月邢台市第三医院收治的124例乳腺癌患者,均行即刻乳房重建术治疗。收集患者年龄、分型、临床获益、无进展生存时间、PAM50基因突变情况等病例资料,根据PAM50基因突变情况分为突变组和无突变组,比较两组患者病例资料差异。采用多因素Logistic回归分析影响乳腺癌疗效的因素,采用受试者工作特征(ROC)曲线分析PAM50基因突变预测术后生存的价值。结果:124例乳腺癌患者中PAM50基因突变28例(22.58%),其中突变组患者的临床获益率、无进展生存时间明显低于或者短于无突变组(P<0.05)。Logistic回归分析显示,PAM50基因突变(OR=2.146,95%CI 1.198~3.831)、TNM分期(OR=2.846,95%CI 1.230~6.586)均是影响治疗效果的危险因素(P<0.05)。入组患者随访3年,死亡45例(36.29%),其中突变组死亡15例(53.57%),未突变组死亡30例(31.25%),两组死亡率差异有统计学意义(χ^(2)=4.671,P=0.031)。ROC曲线分析显示,PAM50基因突变预测术后3年生存的曲线下面积为0.813(95%CI 0.752~0.896),特异度、敏感度分别为76.6%、77.8%。结论:乳腺癌患者PAM50基因突变是影响即刻乳房重建术治疗效果的危险因素,并对术后生存情况具有较高的预测价值。

Objective:To study the relationship between PAM50 gene mutation and the curative effect of breast cancer patients undergoing immediate breast reconstruction and its predictive value for postoperative survival.Methods:124 patients with breast cancer in Xingtai Third Hospital from August 2016 to August 2017 were selected and treated with immediate breast reconstruction.The patients’age,pathological type,clinical benefit,progression free survival time,PAM50 gene mutation were collected.According to with or without PAM50 gene mutation,they were divided into mutation group and non-mutation group,and the differences of medical records between the two groups were compared.Multivariate Logistic regression analysis was used to analyze the risk factors affecting the treatment efficacy of breast cancer.Receiver operating characteristic(ROC)curve was used to analyze the value of PAM50 gene mutation in predicting postoperative survival.Results:Among the 124 breast cancer patients,28(22.58%)had PAM50 gene mutation,and the clinical benefit rate and progression free survival time of the mutation group were significantly lower than or shorter than those of the non-mutation group(P<0.05).Logistic regression analysis showed that PAM50 gene mutation(OR=2.146,95%CI 1.198-3.831)and TNM stage(OR=2.846,95%CI 1.230-6.586)were risk factors of treatment effect(P<0.05).After following up 3 years,45 cases(36.29%)died,including 15 cases(53.57%)in mutation group and 30 cases(31.25%)in non-mutation group.The mortality difference between the two groups was statistically significant(χ^(2)=4.671,P=0.031).ROC curve analysis showed that the AUC of PAM50 gene mutation predicting 3-year survival was 0.813(95%CI 0.752-0.896),and the specificity and sensitivity were 76.6%and 77.8%,respectively.Conclusion:PAM50 gene mutation,which has high predictive value for postoperative survival,in breast cancer patients is a risk factor affecting the treatment efficacy of immediate breast reconstruction.