腋窝淋巴结阴性年轻乳腺癌患者的远期生存分析

Long-term Survival Analysis of Young Breast Cancer Patients with Negative Axillary Lymph Nodes

[目的]分析腋窝淋巴结阴性年轻乳腺癌患者的远期生存和影响预后的因素。[方法]1997年1月至2004年12月共手术治疗101例腋窝淋巴结阴性年龄≤35岁的乳腺癌患者。通过病例记录和系列随访收集患者的临床病理资料和生存情况。生存率计算采用KaplanMeier法,组间比较采用Log-rank检验,多因素预后分析采用Cox比例风险模型。[结果 ]中位随访12.18年（0.18~19.47年）,全组共有3例患者失访,10例发生局部复发和/或区域淋巴结转移,10例远地转移（其中6例同时伴有区域复发）,11例第二原发恶性肿瘤,13例患者死亡。全组10年无病生存率、无疾病复发生存率、无远地转移生存率和生存率分别为70.0%、75.1%、83.4%和87.2%。淋巴结解剖个数≤10个是影响生存的因素（P=0.036）。肿瘤大小是影响疾病复发的独立因素（P=0.050）,但对远地转移和生存均无影响。[结论]腋窝淋巴结阴性年轻乳腺癌患者的远期预后尚好,肿瘤大小和腋窝淋巴结解剖个数分别是疾病复发和生存的影响因素。

[Purpose] To analyze the long-term survival of young breast cancer patients with negative axillary lymph nodes and to evaluate factors influencing the prognosis. [Methods] One hundred and one breast cancer patients aged 35 years or less with negative axillary lymph node were identified in our institution between January 1997 and December 2004.Clinicopathological data and survival information were collected through medical records and sequential follow-up. Survival rates were analyzed with Kaplan-Meier method and compared with Log-rank tests;multivariate analysis was used with Cox＇s proportional hazards model. [Results] After a median follow-up of12.18 years（range 0.18~19.47 years）,3 patients lost follow-up,10 patients had local relapse and/or regional lymph node metastasis,10 patients had distant metastases（6 with regional relapse）,11 patients had second primary malignant tumors and 13 patients died. The 10-year disease-free survival（DFS）,recurrence-free survival（RFS）,distant disease-free survival（DDFS） and overall survival（OS）rates were 70.0%,75.1%,83.4% and 87.2%,respectively. The number of dissected axillary lymph nodes≤10 was associated with poor prognosis,in term of death（P=0.036）. Tumor size was an independent risk factor of RFS（P=0.050）,but not of DFS,DDFS and OS. [Conclusion] The long-term prognosis of young breast cancer patients with negative axillary lymph node is relatively well. Tumor size and the number of dissected axillary lymph nodes are associated with RFS and OS,respectively.