复发转移性三阴性乳腺癌临床特征及总生存分析

Clinical characteristics and overall survival of recurrent metastatic triple-negative breast cancer

目的分析复发转移性三阴性乳腺癌患者的治疗方式及总生存情况。方法回顾性分析复发转移后来我院治疗,并随访至病亡的78例三阴性乳腺癌患者临床资料,根据其临床特征、复发情况及治疗方式评价其总生存情况。结果 78例患者总生存时间（OS）为6-236个月,中位OS为32.1个月。1年生存率92.3%,5年生存率28.2%,10年生存率6.4%。71例（91.0%）三阴性乳腺癌患者行根治术或改良根治手术,其无病生存时间（DFS）为1-184个月,中位DFS为15.0个月,7例（9.0%）患者为初治Ⅳ期。Ⅰ期三阴性乳腺癌患者OS为19.7-236个月,中位OS为90.0个月。复发转移后OS为3.0-93.3个月,中位OS为14.4个月。13例（16.7%）患者局部复发或单纯部位转移的患者行局部手术治疗联合全身治疗者中位OS为26.5月,65例（83.3%）仅行全身治疗者中位OS为12.2个月（P=0.034）。一线化疗方案含紫杉类药物的患者中位OS为14.6个月,未予紫杉类药物的患者中位OS为11.0个月（P=0.048）。结论复发转移性三阴性乳腺癌整体预后较差,生存期短,但异质性较高,且早期三阴性乳腺癌患者具有明显的生存优势。值得一提的是本文只针对已经有生存节点的患者进行分析,这组患者乳腺癌的恶性程度相对较高。也间接提示三阴性乳腺癌的治疗也不能一概而论。对这些早期复发的患者,目前的辅助治疗可能是不足够的。

Objective To analyze the management, recurrence rate, and overall survival of patients with triple negative breast cancer（TNBC）. Method Retrospective analysis was performed for 78 patients who developed advanced disease, of which the clinical characteristics, recurrence, treatment, and survival were evaluated. Result For the 78 patients, the overall survival（OS） was 6-236 months（median OS： 32.1 months）. The 1-, 5- and 10-year survival rate was92.3%, 28.2%, and 6.4%, respectively. 71（91%） patients who received radical surgery or modified radical mastectomy showed a disease- free survival（DFS） of 1- 184 months, and median DFS was 15.0 months, 7（9.0%） patients were in stage IV initially. The TNBC patients at stage I had OS of 19.7-236 months（median OS： 90.0 months）. While the OS was 3.0- 93.3 months（median OS： 14.4 months） after recurrence and metastasis. 13（16.7%） patients with local recurrence or limited distant metastasis who received local surgery plus systemic therapy had 26.5 months of median OS,whereas 65（83.3%） cases who just received systemic therapy achieved only 12.2 months of median OS（P=0.034）. For patients treated with or without taxane-based first-line therapy, the median OS was 14.6 months and 11.0 months, respectively（P=0.048）. Conclusion Recurrent metastatic triple-negative breast cancer patients are heterogeneous, with quite poor prognosis and short overall survival, besides, those who in early stage will have better overall survival. It is noteworthy that this is a group that has complete final survival data, of which the disease is more aggressive, suggesting that the triple negative breast cancer could not be simply treated with single agents, for those who had aggressive and recurrent disease in early stage, the current adjuvant therapy may just be under-treatment.