乳腺癌术后死亡风险时间分布规律研究

Time distribution of the mortality hazard for breast cancer patients undergoing surgery

目的研究中国乳腺癌病人术后死亡风险时间分布规律。方法回顾性研究1992年1月至2003年12月复旦大学附属肿瘤医院手术治疗并且资料完整的原发性乳腺癌2214例临床资料,对其进行生存及死亡风险分析。结果单因素和多因素生存分析均提示肿瘤大小、腋下淋巴结转移状态和孕激素受体状态是影响总存活率的预后因素(P<0.05)。全组病人年死亡风险曲线呈现双峰型,死亡高峰分别位于术后第2年及术后第9.5～10年,且该死亡模式在肿瘤较大及淋巴结阳性的亚组中更为明显。激素受体状态虽不改变病人的双峰型复发模式,但却呈现出一定的时间依赖性。结论乳腺癌术后死亡风险时间分布呈现出一定的规律,针对性制定术后随访和辅助治疗的新策略,可能有助于改善乳腺癌的治疗效果。

Objective To investigate the rule of mortality risk for breast cancer patients undergoing surgery in China. Methods We performed a retrospective study of 2214 female unilateral breast cancer patients with complete data undergoing surgery in our hospital in order to conduct survival and mortality risk analysis. Results Both univariate and multivariate survival analysis indicated that tumor size, axillary nodal status and progesterone receptor （PR） were prognostic factors for overall survival （ P 〈 0.05 ）. Annual mortality hazard curve for entire population showed double-peaked pattern. The analysis according to tumor size and axillary nodal status proved that the double-peaked pattern was almost completely generated by patients with larger tumors and by N ＋ patients. While hormone receptor did not change the bimodal pattern of mortality risk,the results showed that it was a time-dependent variable. Conclusion According to the time distribution of mortality hazard, we could formulate novel strategies for pest-operative treatment and follow-up, which provides the possibility to improve the therapeutic effect and reduce the mortality hazard.