早期乳腺癌患者预后因素分析

Analysis of Prognostic Factors for Patients with Early Breast Cancer

目的:研究T_1～T_2、0～3枚阳性淋巴结乳腺癌患者肿瘤复发和生存的预后因素。方法:回顾分析天津医科大学附属肿瘤医院收治的540例乳腺癌患者资料。进行单因素变量分析及Cox回归分析肿瘤复发和生存的预后因素、结果:>20%阳性腋窝淋巴结率是影响肿瘤局部复发的预后因素(HR=12.816,P<0.001);>20%阳性淋巴结率和浸润性导管癌是影响肿瘤远处转移的预后因素(HR=11.088,P<0.001;HR=0.390,P=0.018);1～3枚阳性淋巴结和>20%阳性淋巴结数是显著影响10年总生存率的预后因素(HR=2.110,P=0.00l;HR=10.244,P<0.001),二者也是影响10年无瘤生存率的预后因素(HR=1.634,P=0.004;HR=7.339,P<0.001)。结论:腋窝淋巴结有无转移是影响10年局部复发,远处转移,总生存率和无瘤生存率的重要的预后因素。原发肿瘤组织病理是显著影响10年肿瘤远处转移的预后因素。

Objective： To identify prognostic factors for patients with T~ to T2 breast cancer and 0 to 3 positive axillary lymph nodes. Methods： Data from 540 breast cancer patients with T1-T2 tumors and 0 to 3 positive nodes were reviewed. The 10-year loco-re- gional recurrence （ LRR ）, distant recurrence （ DR ）, disease-free survival （ DFS ） and overall survival （ OS ） of the patients were analyzed. Univariate statistical analysis and Cox proportional hazards models were carried out using SPSS software v.16.0. Results： The median follow-up was 7.2 years. In multivariate analysis, the positive rate of over 20% of axillary node was the only variable that adversely influenced LRR （ hazard ratio [ HR ], 12.816; 95% confidence interval, 4.657-35.266, P 〈 0.001 ）. The positive rate of over 20% of axillary node and ductal carcinoma were the variables that adversely influenced DR （ HR, 11.088, 95% confidence interval, 3.807-32.297, P 〈 0.001; HR, 0.390, 95% confidence interval, 0.179-0.851, P ~ 0.018 ）. One to 3 positive axillary nodes and the rate of over 20% of positive axillary nodes were the only variables that had negative effect on the 10-year OS rate （HR, 2.110, 95% confidence interval, 1.364-3.264, P = 0.001; HR, 10.244, 95% confidence interval, 3.497-30.011, P 〈 0.001 ） and they were also adverse prognostic factors for the 10-year DFS （ HR, 1.634, 95% confidence interval, 1.171-2.279, P = 0.004; HR, 7.339, 95% confidence interval, 2.906-18.530, P 〈 0.001 ）. Conclusion： The status of axillary lymph node is the only prognostic factor having a significant impact on the 10-year LRR, DR, OS and DFS. Patients with T1-T2 breast cancer and 1 to 3 positive lymph nodes showed higher 10-year LRR and DR, and lower 10-year OS and DFS, compared with patients with negative lymph nodes. The histopathologic results of primary tumors are the significant prognostic factors for 10-year DR.