乳腺癌激素受体状态与复发风险分布特征的相关研究

Time distribution of postoperative recurrence for breast cancer patients with different hormonereceptor status

目的研究不同激素受体（hormone receptor，HR）状态的乳腺癌患者术后复发风险时间分布特征。方法回顾性研究北京肿瘤医院乳腺中心自1999年12月—2006年4月手术的1099例原发性乳腺癌患者激素受体状态的复发风险曲线模式。结果所有患者均获得随访，中位随访时间60．6个月，1099例患者中171例复发。激素受体阴性（hormone receptor—negative，HR-）的乳腺癌患者，在术后第12个月出现第一个复发高峰，54个月左右出现第二个复发高峰。激素受体阳性（hormone receptor—positive，HR＋）患者的第一峰在36个月出现，峰值较低且上升较缓和，约在54个月出现第二高峰，随后激素受体阳性肿瘤患者复发风险曲线高于激素受体阴性者。淋巴结阳性（1ymphnode．positive，LN＋）组与阴性（1ymphnode—negative，LN-）组在HR一组与HR＋组有类似的复发风险曲线模式，淋巴结转移越多复发风险越高。HR＋组中LN＋亚组复发风险峰值高于LN-亚组2—3倍，HR-组中LN＋亚组复发风险峰值高于LN-亚组3～4倍。HR（＋）组无复发生存率高于HR（-）组（P〈0．01）。结论HR＋组乳腺癌术后54个月时复发风险高于HR-组，HR＋组中LN＋患者复发风险高于LN-者。

Objective To study the time distribution of recurrence for postoperative breast cancer patients by hormone receptor status. Methods The characteristics of recurrence in 1099 breast cancer patients with different hormone receptor status undergoing surgery between December 1999 and April 2006 were analyzed retrospectively. Results For those 1099 patients the median follow-up time was 60. 6 months. Recurrence was found in 171 patients. For hormone receptor-negative （HRN） patients the first peak of recurrence appeared at the 12th month and the second at about the 54th month. For hormone receptor-positive （HRP） patients the peak of recurrence appeared at the 36th month and a second peak at about the 54th month, and beyond 54 months the hazard was higher for hormone receptor-positive patients. The risk of recurrence was higher with more nodes involved. Node-positive HRP patients suffered two to three times higher risk of recurrence than node-negative HRP patients. Node-positive HRN patients had three to four times higher risk of recurrence than node-negative HRN patients. The recurrence-free survival in HRP patients was higher than that in HRN patients, also the recurrence-free survival in node-negative HRP patients was higher than that in node-positive patients （ all P 〈 0.01 ）. Conclusions The recurrence risk for HRP breast cancer patients was higher than that in HRN patients after 54 months postoperatively. The risk of recurrence for node-positive breast cancer patients was higher than that for HRP node-negatives.