乳腺浸润性乳头状癌预后影响因素分析

Analysis of prognostic factors of breast invasive papillary carcinoma

目的分析影响乳腺浸润性乳头状癌预后的影响因素。方法获取从1990年开始登记在美国监测、流行病学、最终结果项目(surveillance,epidemiology,and end results program,SEER)数据库中并诊断为乳腺浸润性乳头状癌的女性病例,按照纳入和排除标准选择符合本研究的对象。描述研究资料的临床病理分布情况,采取Cox比例风险回归模型进行单因素和多因素分析预后的相关因素。结果纳入本研究有1413例乳腺浸润性乳头状癌,其中肿瘤特异性死亡106例。Cox单因素分析发现,组织分化、雌激素受体(ER)、孕激素受体(PR)、T分期、N分期、M分期、手术、化疗是影响预后的相关因素(P<0.05)。多因素分析发现淋巴结转移的分期越高则发生不良预后的风险越高,T4期病例发生不良预后的风险是T1期病例的2.217倍(95%CI=1.056~4.655),PR阴性组病例死亡风险是PR阳性病例的2.136倍(95%CI=1.252~3.644),采取保乳手术发生死亡风险是未手术病例的0.086倍(95%CI=0.029~0.252),是否化疗对生存预后的差异无统计学意义(P=0.329,HR=0.787)。结论肿瘤大、局部晚期、淋巴结转移、PR阴性、不接受治疗的病例发生肿瘤特异性死亡风险较高。早期手术干预浸润性乳头状癌可减慢疾病进展并改善预后,辅助放疗和化疗对病人的生存预后无显著影响。

Objective Analysis of prognostic factors of invasive papillary carcinoma of the breast.Methods To obtain female cases of invasive papillary carcinoma of the breast that have been registered in the Surveillance,Epidemiology,and End Results Program(SEER)database in the United States since 1990.According to the inclusion and exclusion criteria,the subjects in accordance with this study were selected.The clinicopathological distribution of the study data was described,and the Cox proportional hazard regression model was used to analyze the prognostic factors by univariate and multivariate analysis.Results A total of 1413 cases of invasive papillary carcinoma of the breast were included in this study,of which 106 cases died specifically.Cox univariate analysis showed that tissue differentiation,estrogen receptor(ER),progesterone receptor(PR),T stage,N stage,M stage,operation and chemotherapy were related factors affecting prognosis(P<0.05).Multivariate analysis showed that the higher the stage of lymph node metastasis,the higher the risk of poor prognosis.The risk of poor prognosis in stage T4 was 2.217 times higher than that in stage T1(95%CI=1.056 to 4.655).The risk of death in the PR negative group was 2.136 times higher than that in the PR positive group(95%CI=1.252 to 3.644),and the risk of death in breast conserving surgery was 0.086 times higher than that in the unoperated group(95%CI=0.029 to 0.252).There was no significant difference in survival and prognosis between chemotherapy and chemotherapy(P=0.329,HR=0.787).Conclusion Patients with large tumor,locally advanced tumor,lymph node metastasis,negative PR and no treatment had a higher risk of tumor specific death.Early surgical intervention of invasive papillary carcinoma can slow down the progression of the disease and improve the prognosis,adjuvant radiotherapy and chemotherapy have no significant effect on the overall survival and prognosis of patients.