T_(1mic)N_0M_0、T_(1a)N_0M_0和T_(1b)N_0M_0乳腺癌376例临床特征和预后分析

Clinical features and prognosis of 376 patients with T_(1mic)N_0M_0,T_(1a)N_0M_0 and T_(1b)N_0M_0 breast cancer

目的:分析T1micN0M0、T1aN0M0和T1bN0M0乳腺癌患者的临床病理学特征,了解其生存状态,探讨与预后相关的独立影响因素。方法:收集2002年1月—2005年12月4487例可手术的乳腺癌患者的临床病理学资料,回顾性分析其中376例T1micN0M0、T1aN0M0和T1bN0M0患者的临床病理学特征、复发和转移以及生存情况。结果:376例患者中,66例(17.6%)为T1mic(pT≤0.1cm),122例(32.4%)为T1a(0.1cm<pT≤0.5cm),188例(50.0%)为T1b(0.5cm<pT≤1.0cm)。肿瘤直径越大,其组织学分级越高、雌激素受体阳性率越低、辅助化疗率越高(P<0.05)。单因素分析显示,年龄、激素受体和HER-2状态是5年无病生存的影响因素。多因素分析显示,HR和HER-2状态是5年无病生存的独立影响因素。HR阳性组中,HER-2阳性患者的5年复发风险是阴性组的约4倍(风险比为4.995,95%可信区间为1.113～22.424);HR阴性组中,HER-2阳性与阴性患者的差异无统计学意义(风险比为2.757,95%可信区间为0.849～8.955)。结论:HR和HER-2状态是T1micN0M0、T1aN0M0和T1bN0M0乳腺癌患者5年无病生存的独立影响因素。HR阳性时,HER-2阳性患者的复发风险较高。

Objective：To analyze the clinicopathological features and prognosis of patients with T1micN0M0,T1aN0M0 and T1bN0M0 breast cancer,and to evaluate the survival and independent prognostic factors.Methods：The clinicopathological data from 4 487 patients who could receive surgical operation between January 2002 and December 2005 were collected.The clinicopathological features,recurrence,metastasis and survival of 376 patients with T1micN0M0,T1aN0M0 and T1bN0M0 breast cancer were retrospectively analyzed.Results：Three hundred and seventy-six eligible patients were identified.Of these 376 patients,66 patients（17.6%） had T1mic breast cancer（pT≤0.1 cm）,122 patients（32.4%） had T1mic breast cancer（0.1 cmpT≤0.5 cm）,and 188 patients（50.0%） had T1b breast cancer（0.5 cmpT≤1.0 cm）.With the lager tumor size,the histology grade was higher,the positive rate of estrogen receptor was lower,and the incidence of adjuvant chemotherapy was higher（P0.05）.Univariate analysis showed that the age,hormone receptor and HER-2 status were prognostic factors for 5-year disease-free survival.Multivariate analysis showed that the hormone receptor and HER-2 were prognostic factors for 5-year disease-free survival.The 5-year recurrence risk in the positive hormone receptor group was four times as high as that in the negative hormone receptor group（hazard ratio was 4.995,95% confidence interval was 1.113-22.424）.In negative hormone receptor group,there was no statistically significant difference in the risk of 5-year recurrence between patients with positive HER-2 and negative HER-2（hazard ratio was 2.757,95% confidence interval was 0.849-8.955）.Conclusion：HR and HER-2 status were independent prognostic factors for 5-year DFS in T1micN0M0,T1aN0M0 and T1bN0M0 breast cancer.Hormone receptor positive disease with positive HER-2 status was associated with a high risk of cancer recurrence.