应用对比风险模型分析影响乳腺癌复发的预后因素

Factors influencing recurrence of patients with primary breast cancer using competing risks analyses

目的 综合分析几种预后因素对乳腺癌不同复发类型的影响。方法 收集我院在 1975年 5月 1日～ 1996年 1月10日收治的 6 81例浸润型乳癌临床资料 ,应用对比风险模型 ,研究了年龄、肿瘤大小、淋巴结状态、ER(雌激素受体 )、PgR(孕激素受体 )、辅助治疗 (激素、化疗、放疗 )等传统预后因素对乳癌不同复发类型 (局部、远处 )和首次复发时间的影响。结果 对所有年龄组 ,有 5个与复发类型或首次复发时间显著相关的预后因素 :放疗是唯一只影响局部复发的因素 (P <0 0 5 ) ;年龄、肿瘤大小、淋巴结状态、化疗与局部和远处复发均显著相关 ,尤其与首次复发时间相关。对≥ 6 5岁年龄组 ,几种因素均不影响复发类型 ,只有肿瘤大小和淋巴结状态与首次复发时间显著相关。结论 各种预后因子对乳腺癌局部与远处复发的影响不同 ;

Objective The aim of this study was to assess simultaneously the effects of prognostic factors on different types of first recurrence of the patients with breast cancer Methods Data for a cohort of 681 primary invasive breast cancer patients cured betwwen 1975～1996/1/10 on Xinqiao Hospital We investigated the effects of the traditional factors of age,tumor size,nodal status,ER,PgR,adjuvant therapy (hormone,chemotherapy,radiotherapy) on type of recurrence and time to first recurrence.Results Adjuvant radiation was the only factor which had an effect(p<0 05) on the type of first recurrence being associated with a reduction in local recurrence Age,nodal status,tumor size and adjuvant chemotherapy all had significant associations across all types of first recurrence,and in particular with time to recurrence for both local and distant metastasis For patients≥65 years of age,there were no factors which differentially affected type of recurrence,while only nodal status and tumor size had significant associations with time to recurrence.Conclusion Prognostic factors may differentially affect the type of recurrence for breast cancer patients;Competing risks analyses proved to be helpful for us to select the treatment regimen appropriate for patients