1544例乳腺浸润性导管癌临床特点和生存率的多因素分析

The clinical characteristics and multivariate analysis of survival rates for 1544 cases of invasive ductal carcinoma of the breast

目的 分析乳腺浸润性导管癌的临床特点和预后因素。方法 1 544 例浸润性导管癌全部为九十年代新发病例。采用观察生存率、死亡危险比、Log rank检验和拟合多因素Cox比例风险回归模型等进行单因素和多因素分析,评估各种预后因素与乳腺癌的联系强度。结果 浸润性导管癌占女性乳腺癌的82.5%,腋淋巴结转移率44.2%。外上象限发病最多,占47.7%。肿块位中央区,腋淋巴结阳性率最高,占61.7%。Ⅰ、Ⅱ、Ⅲ、Ⅳ期病例分别占30.0%,59.4%,9.4%,1.2%;5年和10年生存率分别为94.9%,78.1%;48.1%,8.6%和87.2%,67.1%;31.2%,0.0%。单因素分析:发病年龄、肿块大小、腋淋巴结转移数、TNM分期、治疗方式与生存率有关;ER、PR、Her- 2/neu、手术类型与生存率无关。多因素分析显示:发病年龄、腋淋巴结转移数、治疗方式与生存率有关。结论 腋淋巴结状况是制定治疗方案和评估预后的最主要指标。50 岁以下发病的患者以及接受综合治疗的患者生存率较高。九十年代与八十年代相比,上海市区女性乳腺癌的诊治水平有了较大的提高。

Objective To analyze the clinical characteristics and prognostic factors for invasive ductal carcinoma (IDC).Methods 1544 IDCs were diagnosed in 1990s. The observed s urvival rates, hazard ratio, Log-rank test and fitting multivariate Cox proport ional hazard regressive model were used in order to estimate strength of relatio ns between various clinical indicators, and prognoses of the patients with breas t cancer. Results IDCs in female breast cancer accounted for 82.5%, a xillary lymph nodes (ALN) containing metastases accounted for 44.2%. The tumors in upper-outer quadrant accounted for 47.7%. The tumors in central portion, ALN (+)accounted for 61.7%. The stages different cases of Ⅰ,Ⅱ,Ⅲ and Ⅳ, their inc idences were 30.0%, 59.4%, 9.4% and 1.2%, respectively; 5-year and 10- year survival rates were found 94.9%,71.1%,48.1%,8.6% and 87.2%, 67.1 %, 31.2%,0.0%, respectively. One way analysis showed age , tumor size, No. of ALN(+), TNM stage and combined treatment were related to survival rates; ER, PR, Her-2/neu and surgical type were not related to survival rates. Multivariat e analysis showed age, No of ALN(+) and combined treatment were related to survi val rates.Conclusion The ALN status is a most important indicator for mak ing treatment pian and prognosis assessment. The patients who are under 50 years old and accept combined treatment have higher survival rates. To make compariso m between 1990s and 1980s, the level of diagnosis and treatment for female breas t cancer in urban Shanghai has made considerable enhancement.