乳腺癌术后内分泌治疗5年复发危险因素分析

Risk factors for recurrence after 5-year endocrine therapy in postoperative breast cancer patients

目的探讨乳腺癌5年内分泌治疗后复发的危险因素。方法筛选2006年1月至2011年12月间经手术治疗的ER阳性乳腺癌患者，术后内分泌辅助治疗达5年，共327例。生存分析采用Kaplan-Meier曲线评估和Log-rank检验比较，并用COX回归模型进行单因素和多因素分析。结果34例（10．4％）患者在5年的辅助内分泌治疗后发生了局部复发，42例（12．8％）患者发生远处转移。生存分析显示，组织学3级、淋巴结转移、Ki-67高表达、高TNM分期及放疗患者有更差的无复发生存（RFS）率（P=0．000，0．003，0．008，0．004，0．034）和更差的无远处转移生存（DMFS）率（P=0．000，0．002，0．032，0．010，0．023），差异均有统计学意义。多因素分析显示：组织分级3级、超过3个淋巴结转移（均P〈0．05）是乳腺癌RFS独立危险因素；组织学3级（P〈0．05）是乳腺癌DMFS独立危险因素。结论乳腺癌辅助5年内分泌治疗后复发转移仍然常见，组织学分级3级和超过3个淋巴结转移的患者可能从延长内分泌治疗中获益。

Objective To evaluate recurrence risk factors in postoperative breast cancer patients after 5-year adjuvant endocrine therapy. Methods From Jan 2006 to Dec 2011, a total of 327 patients were enrolled for this study. Kaplan-Meier curves were applied to estimate survival rates and COX＇s proportional hazards model to identify prognostic variables. Results Among these 327 eligible patients, 42 （ 12. 8% ） patients suffered from distant metastasis and 34 （ 10. 4% ） patients experienced locoregional recurrence after 5-year adjuvant endocrine therapy. Survival analysis showed that patients with histologic grade 3 disease, lymph node metastasis, Ki-67 high expression, high TNM stage and radiotherapy were statistically significant with poorer relapse-free survival （ RFS, P = 0. 000, 0. 003, 0. 000, 0. 003, 0. 034） and poorer distant metastasis-free survival （ DMFS, P = 0. 000, 0. 002, 0. 000, 0. 002, 0. 023 ） , respectively. In multivariate analysis, patients with histological grade 3 disease （ P = 0. 002） and more than 3 positive nodes （P = 0. 032 ） were risk factors for lower RFS. However, only histological grade 3 （ P = 0. 015 ） was risk factor for DMFS. Conclusions Late relapse after completion of 5-year adjuvant endocrine therapy was still common, patients with grade 3 disease and more than 3 positive nodes may benefit from extended endocrine therapy.