年轻乳腺癌(≤35岁)患者死亡风险规律的分析

Analysis on the rule of mortality risk in young women(≤35 years) with primary breast cancer

背景与目的:年轻乳腺癌患者(≤35岁)预后较差,可能具有与35岁以上乳腺癌患者不同的生物学特性,但年轻乳腺癌的死亡风险规律及其与35岁以上患者之间的差异目前国内外尚无研究报道。本研究对年轻乳腺癌患者的临床病理学特征、预后及死亡风险规律进行分析以期进一步了解本类乳腺癌的特点。方法:回顾性研究我院1990年1月—2005年10月间手术治疗的2 331例原发性乳腺癌患者,以35岁为临界点分组,采用Kap-lan-M e ier法及风险函数分别估计两组患者的总生存曲线和年死亡风险曲线,并分析两组患者临床病理学指标间的差异、总生存曲线及年死亡风险规律间的异同。结果:在肿瘤大小(P=0.0231)、腋下淋巴结转移状态(P<0.001)、雌激素受体状态(P=0.064)等方面,≤35岁及>35岁年龄组间差异均有显著性。年轻乳腺癌的10年总生存率较>35岁乳腺癌患者为差(分别为72%和79%,P=0.0081)。>35岁患者的年死亡风险曲线呈双峰型(V型),而年轻乳腺癌患者的年死亡风险除呈现出与前者相似但时间提前的双峰型图形外,在前后两个死亡高峰间还存在着比>35岁患者高的死亡小峰(W型)。结论:≤35岁与>35岁的乳腺癌患者具有不同的肿瘤生物学行为,在总生存率及死亡模式上存在一定差异,提示对年轻乳腺癌的随访和治疗可能应采用不同的原则和措施。

Background and purpose： The prognosis of young women （ ≤35 years） with breast cancer is poorer than that of women over 35 years, which may indicate that they bear different biologic characteristics. However, such data are still not available at home and abroad as the rule of mortality risk in young women and its distinction from that in women over 35 years. We investigate the clinical characteristics, prognosis and the rule of mortality risk in young women （ ≤35 years） with primary breast cancer. Methods： A total of 2 331 women with primary breast cancer were divided into two groups with the cut-off of 35 years. Overall survival curve was estimated by Kaplan-Meier method and annual mortality hazard by hazard function. Their clinicopathologic indices, overall survival curve and annual mortality hazard were analyzed. Results： There was statistical significance between ≤35 and 〉 35 years group in terms of tumor size（ P = 0.0231）, axillary nodal status（ P 〈 0.001） and estrogen receptor status（ P = 0.064）. 10-year overall survival was 72% and 79% （ P = 0.0081 ）, respectively, for ≤35 and 〉 35 years group. Correspondingly, mortality pattern for the two groups exhibits W-shape and Vshape. Conclusions： Between the two groups, different tumor biology leads to the discrepancy of overall survival and mortality pattern, which might indicate distinct principles and measures in the follow-up and treatment for young patients.