青年女性三阴性乳腺癌的临床病理学特征及其影响预后的多因素分析

Clinical Pathological Characteristics and Multiple Factors Affecting the Prognosis of Young Women with Triple-negative Breast Cancer

目的：探讨青年（年龄≤35岁）女性三阴性乳腺癌（TNBC）和非三阴性乳腺癌（NTNBC）腋窝淋巴结转移（ALNM）患者的临床病理学特性与影响预后的危险因素。方法：回顾性分析2005年1月至2008年12月在青岛大学附属医院住院手术治疗并经临床病理学证实的136例青年女性乳腺癌患者的临床资料。根据免疫组化检测结果将其分为TNBC组（75例）和NTNBC组（61例）；对比分析两组青年女性乳腺癌患者在年龄、婚姻、妊娠、生育、哺乳、乳腺癌家族史、病程、临床病理学分类、肿瘤组织学分级、肿瘤最大直径、ALNM、脏器转移及临床分期与生存期之间的相关性。5年总生存期（0S）和无瘤生存期（DFS）分析采用Ka—plan-Meier法。影响预后的因素采用Cox比例风险回归模型分析。结果：本组青年女性乳腺癌136例，占同期手术治疗乳腺癌1063例的12．79％；在218例（20．51％）TNBC患者中，青年女性TNBC患者75例（34．40％）；青年女性NTNBC患者61例，占845例NTNBC患者的7．22％。在乳腺癌家族史（21．33％ vs 5．19％）和病程〉5个月（29．33％ vs 19．67％）等临床特征中，两组乳腺癌患者比较有统计学意义（P〈0．05）。在肿瘤最大直径〉5cm（20．00％ vs 8．20％）、肿瘤组织学分级Ⅲ级（46．67％ vs 31．15％）、临床分期Ⅲ期（25．33％ vs 11．48％）、术后局部复发（17．33％ vs 11．48％）、ALNM（57．033％ vs 39．34％）以及脏器转移（16．00％ vs 4．92％）等临床病理学特征性指标中，两组乳腺癌患者比较存在明显差异（P〈0．05）。5年OS和DFS分别为76．47％和67．65％；TNBC5年OS和DFS分别为69．33％和60．00％，NTNBC5年Os和DFS分别为85．25％和77．05％。比较两组乳腺癌的5年OS及DFS存在明显差异（x^=4．374，P=0．030；x^2=4．4684，P=0．035）。Cox回归分析结果表明：病程和乳腺癌家族史是TNBC患者的隐匿性和易感性因素；肿瘤最大直径、肿瘤组织学分级、术后局部复发、临床分期、ALNM和脏器转移等6项指标是影响青年女性TNBC患者预后的危险因素（x^2=6．684-5．058，P=0．048-0．025）。结论：青年女性TNBC患者具有乳腺癌家族倾向、病情隐匿、临床分期晚、增殖侵袭性强、复发转移率高、预后较差的临床病理学特征，也是影响预后的危险因素。

Objective： To investigate the youth 35 years old or less women of triple-negative breast cancer （TNBC） and non triple-negative breast cancer （NTNBC） and axillary lymph node metastasis （ALNM） of clinical characteristics and pathological biological characteristics and risk factors affecting the prognosis. Methods： Retrospective analysis from January 2005 to December 2008 in Qingdao university affiliated hospital during surgery and confirmed by clinical pathology of the clinical data of 136 cases of young female breast cancer patients. According to the immunohistochemical detection results will be divided into TNBC group （75 cases） and NTNBC group （61 cases）. Two groups of young female breast cancer compared in age, marriage, pregnancy, maternity, breast-feeding, and family history of breast cancer, the course of the disease, pathological type, histological grade, tumor size, ALNM, distant metastasis, and the correlation between survival and clinical stage. The overall survival （OS） and disease flee survival （DFS） in 5 years analysis by Kaplan Meier-method. Factors influencing the prognosis of the Cox proportional hazards regression model analysis. Results： Of young women, 136 cases of breast cancer, accounted for 12.79% of the surgical treatment of 1063 cases of breast cancer at the same period; In 218 cases （20.51%） were TNBC, Young female TNBC 75 cases （34.40%）. Young women NTNBC 61 cases, accounted for 7.22% of all NTNBC 845 cases. Two groups breast cancer of patients with at family history （21.33% vs 5.19%）, course of〉 5 months （29.33% vs 19.67%） and other clinical features in comparison with statistical significance （P〈0.05）. In histology grade Ⅲ （46.67% vs 31.15%）, tumor di-ameter 〉 5cm （20.00% vs 8.20% ）, clinical stage Ⅲ vs 25.33% vsl 1.48%, postoperative local rectu＇rence （17.33% vs 11.48% ）, ALNM （57.33%vs 39.34%） and vis-cera metastasis （16.00% vs 4.92%） pathological biological indexes such as two groups of patients with breast cancer, there is significant difference （P 〈0.05）. 5 years DFS and OS distinguish were 76.47% and 67.65% ,TNBC group distinguish were 69.33% and 60.00%, NTNBC group distinguish were 85.25% and 77.05%, two groups of patients with breast cancer, there is signifi-cant difference （x^=4.374, P=0.030; x^2=4.468 4, P=0.035）. Cox regression analysis results showed that course of the disease and family history of breast cancer were factor ofmunity. In tumor diameter, histological classification, clinical stage, postoperative local recurrence, ALNM and viscera transfer 6 indicators that affect young female a risk factor for the prognosis of patients with TNBC （x^2=6.868-7.035,P=0.024-0.021）. Conclusion： Young female patients with TNBC is family genetic predisposition, late clinical stage, proliferating inva-sive recurrence of strong, high transfer rate and poor prognosis of the clinical and pathological characteristics, risk factors also affect out-comes.