乳腺癌患者术后辅助治疗的临床效果及其影响因素分析

Clinical effect and influencing factor analysis of postoperative adjuvant therapy for patients with breast cancer

目的：分析476例乳腺癌术后辅助治疗患者的病理、临床资料及预后情况,探讨影响乳腺癌预后的相关因素。方法：随访2007—2010年本院乳腺癌术后病理分期为Ⅰ~Ⅲ期且行辅助治疗的患者476例,中位随访时间为50.5个月,采用Kaplan-Meier法绘制生存曲线,Log-rank检验进行生存率差异比较,采用COX比例风险回归模型进行单因素及多因素分析,了解影响乳腺癌预后的相关危险因素。结果：患者3年无病生存率为94.3%。单因素分析,年龄、肿瘤大小、淋巴结转移数目、脉管癌栓、激素受体状态、HER-2表达情况和分子分型是影响无病生存期（DFS）的因素（P〈0.05）;其中年龄越小、肿瘤越大、淋巴结转移越多、脉管癌栓越多、激素受体阳性率越低、HER-2表达扩增和分子分型是HER-2过表达型及基底样型,DFS越短。多因素分析,激素受体状态和HER-2表达情况是影响DFS的独立因素（P〈0.05）。3年总生存率为97.6%。单因素分析,肿瘤大小、淋巴结转移情况、脉管癌栓、激素受体状态和HER-2表达情况是影响乳腺癌总生存期（OS）的因素（P〈0.05）;其中肿瘤越大、淋巴结转移越多、脉管癌栓越多、激素受体阳性率越小和HER-2表达扩增,OS越短;多因素分析,淋巴结转移数目、激素受体状态和HER-2表达情况是影响OS的独立因素（P〈0.05）。结论：淋巴结转移数目、激素受体状态和HER-2表达情况是乳腺癌术后辅助治疗疗效的影响因素,与预后有密切关联。

Objective To analyze the clinical pathologic characteristics,treatment and prognosis of 476 breast cancer patients,and to explore the related factors influencing the prognosis of breast cancer.Methods 476 breast cancer patients received postoperative adjuvant therapy were followed up who were diagnosed as the pathologic stageⅠ-Ⅲfrom 2007 to 2010.The median follow-up time was 50.5 months.Kaplan-Meier method was used to draw the survival curve,and Log-rank test was used to compare the survival rates;COX proportional hazards model was used to analyze single factors and multiple factors.The risk factors related to the prognosis of breast cancer were analyzed.Results The 3-year disease free survival rate of the patients was 94.3%.The single factor analysis showed that age,tumor size,the number of metastatic lymph nodes,vascular tumor emboli,hormone receptor status,HER-2expression and molecular subtypes were the influencing factors of disease free survival（DFS）（P〈0.05）.The smaller age,the larger neoplasm,the more metastatic lymph nodes,the more vascular tumor emboli,the lower positive rate of hormone receptor,the over-expression of HER-2,the molecular subtypes of HER-2overexpression and the basal-like subtype had poor prognosis among them.The multifactor analysis demonstrated that hormone receptor status and HER-2expression were independent factors influencing DFS（P〈0.05）.The 3-year overall rate of the patients was 97.6%.The single factor analysis showed that the tumor size,the number of metastatic lymph nodes,vascular tumor emboli,hormone receptor status and HER-2 expression were the influencing factors of overall survival（OS）（P〈0.05）.The multiple factor analysis demonstrated the number of metastatic lymph node,hormone receptor status and HER-2expression were independent factors of OS（P〈0.05）.Conclusion The number of metastatic lymph nodes,hormone receptor status and HER-2 expression are significantly independent indicators of prognosis in the patients with breast cancer respectively.