77例妊娠哺乳期乳腺癌的临床特点及预后分析

The clinical features and prognosis of 77 patients of breast cancer during pregnancy and lactation

目的分析妊娠哺乳期乳腺癌的临床特征及预后因素。方法回顾性分析天津市肿瘤医院2002年1月至2012年12月期间收治的77例患者的临床资料。根据发病时期将其分为妊娠期组（n=23）和哺乳期组（n=54）。寿命表法计算生存率，COX比例风险回归模型进行多因素生存分析。结果全组肿瘤平均最大直径5．9cm，腋窝淋巴结阳性49例。与哺乳期乳腺癌患者相比，妊娠期乳腺癌患者肿瘤直径更大，平均为6．8cm（P=0．031）。中位随访时间39个月，5年无病生存率和5年总生存率分别为52．6％和61．8％。多因素分析显示，影响患者无病生存和总生存的独立预后因素均为哺乳与否和肿瘤大小。结论妊娠哺乳期乳腺癌延误诊断率高，TNM分期晚，预后较差，哺乳与否、肿瘤大小是影响患者预后的独立危险因素。

Objective To explore the clinical features and prognostic factors of breast cancer during pregnancy and lactation. Methods A retrospective analysis was performed on 77 patients admitted to the Tianjin Cancer Hospital from January 2002 to December 2012. According to when the cancer was found, these patients were divided into the pregnancy group （ n = 23 ） and the lactation group （ n = 54）. Survival rate was calculated by life table, Multivariate factors for survival were analyzed by COX proportional hazards regression model. Results The mean maximum diameter of the tumor was 5.9 cm, 49 cases had axillary lymph node metastasis. Compared with the lactation group, the patients in pregnancy group had larger tumor diameter, the mean diameter was 6. 8 cm （P = 0. 031 ）. The median follow-up time was 39 months and 5-year disease-free survival （DFS） rate and 5-year overall survival （OS） rate were 52. 6% and 61.8%, respectively. Multivariate analysis showed that the independent factors of DFS and OS were breastfeeding and tumor size. Conclusions Diagnosis of breast cancer during pregnancy and lactation were usually delayed and often in late TNM stage. Breastfeeding and tumor size are independent prognostic factors.