转移性三阴性乳腺癌的临床、病理特征和治疗方法与无瘤生存率的关系

Clinical, pathological features and treatment of metastatic breast cancer with triple negative breast cancer and its relationship with disease free survival

目的 分析转移性三阴性乳腺癌（TNBC）的临床特征、病理特征、治疗方法及其与无瘤生存率的关系.方法 选择2004年1月至2009年1月在郑州大学第一附属医院和河南省长葛市中医院接受治疗的TNBC患者158例作为研究对象.所有患者均接受手术及放化疗,分析患者临床特征、病理特征、治疗方法与3、5年生存率的关系以及患者复发和转移情况.结果 临床分期为Ⅲ期者的3年生存率为46.51％（20/43）,5年生存率为37.21％ （16/43）,均显著低于Ⅰ期[91.53％ （54/59）、76.27％（45/59）]及Ⅱ期者[87.50％ （49/56）、71.43％（40/56）],差异均有统计学意义（x2值分别为25.306、15.787,19.348、11.592,P均＜0.001）.有淋巴结转移者的3年生存率为66.00％ （33/50）,5年生存率为50.00％（25/50）,显著低于无淋巴结转移者[83.33％ （90/108）、70.37％ （76/108）],差异均有统计学意义（x2值分别为5.954、6.150,P值分别为0.015、0.013）.病理分级为Ⅲ级者3年及5年生存率分别为65.67％（44/67）、43.28％ （29/67）,显著低于Ⅰ级[92.86％（26/28）、85.71％ （24/28）]及Ⅱ级者[84.13％（53/63）、76.19％ （48/63）],差异均有统计学意义（x2值分别为7.527、14.414,5.839、14.560,JD均＜0.05）.放疗者3年生存率为81.58％ （31/38）,显著高于无放疗者[57.69％（15/26）],差异有统计学意义（x2=4.357,P=0.037）.转移部位主要为肺、肝、脑、骨以及锁骨上淋巴结,转移后的中位生存时间均＜2年.结论 TNBC是一种较难治疗的特殊乳腺癌,临床上其治疗方案未达成共识,保乳手术亦有一定的应用价值,放疗仅可提升3年生存率,临床分期及病理分级等均是预后的影响因素.

Objective To study the clinical,pathological features and treatment of metastatic breast cancer with triple negative breast cancer（TNBC） and its relationship with disease free survival.Methods One hundred and fifty-eight cases of TNBC patients who were treated in the First Affiliated Hospital of Zhengzhou University and the Chinese Medicine Hospital of Changge from January 2004 to January 2009 were selected as the research objects.All patients received operation and radiotherapy,the relationship between the clinical characteristics,pathological features and treatment with 5,3 year survival rate,and the recurrence and metastasis of patient were analyzed.Results In clinical stage Ⅲ period,the 3 years survival rate was 46.51% （20/43）,5years survival rate was 37.21% （16/43）,all significantly lower than in the phase Ⅰ and Ⅱ （91.53% （54/59） and 76.27 % （45/59）;87.50% （49/56） and 71.43 % （40/56））,and the differences were statistically significant （x2=25.306,15.787,19.348,11.592;P〈0.001）.With lymph node metastasis,the 3 years survival rate was 66.00% （33/50）,5 years survival rate was 50.00% （25/50）,significantly lower than that without lymph node metastasis（83.33% （90/108）,70.37% （76/108））,the difference was statistically significant （x2=5.954,6.150;P〈0.05）.In pathological grade Ⅲ,the 3 years survival rate was 65.67%（44/67）,5 years survival rate was 43.28% （29/67）,significantly lower than that of grade Ⅰ （92.86% （26/28）,85.71% （24/28）） and grade Ⅱ （84.13% （53/63）,76.19% （48/63））,the difference was statistically significant（x2=7.527,14.414,5.839,14.560;P〈0.05）.The 3 year survival rate of radiotherapy group was significantly higher than that in non radiotherapy group,the difference was statistically significant （81.58% （31/38） vs.57.69% （15/26）;x2=4.357,P〈0.05）.Patients with metastatic sites were lung,liver,brain,bone and supraclavicular lymph nodes,the median survival time after the transfer all more than 2 years.Conclusion TNBC is a special type of breast cancer that is difficult to treat,no consensus has been reached on the clinical treatment plan.Breast conserving surgery also has certain application value,radiotherapy only can increase the 3 year survival rate.The clinical stage and pathological grade are the influence factors of prognosis.