北京妇女绝经状态与不同分子亚型对乳腺癌患者生存的影响

Analysis of the effect of menopausal status and molecular subtype on survivals among breast cancer patients

目的 分析绝经状况与不同分子亚型对北京乳腺癌患者生存的影响,为乳腺癌临床研究以及防治提供基础数据.方法 从北京市肿瘤登记处提取北京4所医院2006—2010年全部北京户籍的乳腺癌病例,通过病历摘录的方式收集患者TNM分期、受体状态、分化度、身高和体重等信息,结合北京肿瘤登记数据和人群肿瘤登记的随访信息获得患者的生存结局.随访截至2015年12月31日,最终纳入4531例浸润性、原发性乳腺癌病例进行分析.根据受体状态不同,将乳腺癌分为Luminal型和非Luminal型两种亚型.采用寿命表法分析未绝经、已绝经患者不同分子亚型乳腺癌生存率,并运用Cox回归模型分析不同分子亚型对乳腺癌生存率的影响.结果 4531例乳腺癌患者中,未绝经患者占44.5%（2017例）,已绝经患者占55.5%（2514例）.调查期间死亡病例643例,调查对象的5年生存率为89.5%（95%CI：88.6%-90.4%）,未绝经患者为92.1%（95%CI：90.9%-93.3%）,已绝经患者为87.5%（95%CI：86.2%-88.8%）.有分子亚型的病例3730例,其中76.7%（2861例）为Luminal型,23.3%（869例）为非Luminal型.Luminal型和非Luminal型乳腺癌患者5年生存率分别为91.8%（95%CI：90.8%-92.8%）、83.2%（95%CI：80.7%-85.7%）.无论是否绝经,非Luminal型乳腺癌患者发生的死亡风险均高于Luminal型（未绝经：HR=1.85,95%CI：1.26-2.73;已绝经：HR=1.42,95%CI：1.07-1.88）.结论 乳腺癌患者无论是否绝经,非Luminal型乳腺癌患者5年生存率均低于Luminal型,是乳腺癌的不良预后因素.

Objective To analyze the associations between molecular subtypes and overall breast cancer survival among premenopausal and postmenopausal breast cancer in Beijing, and to provide basic information for breast cancer clinical researches and control. Methods All the resident patients diagnosed with breast cancer in four well-established hospitals were retrieved from Beijing cancer registry, related information, such as TNM stages, receptor status, histological grade, height, weight, were collected by case extraction. Cancer registration information and population-based follow-up information were used to acquire survival outcome. All the patients were followed up until 31 December 2015, 4531 cases with invasive, primary breast were included in the final analysis. All the cases were classified into Luminal and non-Luminal according to receptor status. Five-year survival rates of the two subtypes were estimated by the life-table method. Multivariable Cox proportional hazards models were employed to evaluate the associations between molecular subtypes and breast cancer survival. Results Of all the 4531 patients, premenopausal patients accounted for 44.5%（2017 cases） and postmenopausal patients accounted for 55.5%（2514 cases）. 643 cases died during the study period. Overall five-year survival was 89.5%（95%CI：88.6%-90.4%）, for premenopausal and postmenopausal patients, they were 92.1%（95%CI：90.9%-93.3%）, and 87.5%（95%CI：86.2%-88.8%）, respectively. Among all the patients, 3730 patients had molecular subtype, 76.7%（2861cases） were Luminal breast cancer, and 23.3% （869 cases） were non-Luminal breast cancer. Five-year survival rates for Luminal and non-Luminal were 91.8% （95%CI： 90.8%-92.8%）, and 83.2% （95%CI：80.7%-85.7%）, respectively. No matter in premenopausal or postmenopausal patients, non-Luminal breast cancer had significantly higher risk of death compared to Luminal breast cancer （premenopausal： HR=1.85, 95%CI： 1.26-2.73; premenopausal： HR=1.42, 95%CI： 1.07-1.88）. Conclusion For both premenopausal and postmenopausal breast cancer patients, non-Luminal breast cancer had lower five-year survival rates than Luminal breast cancer, which was a risk factor on breast cancer survival.