61例三阴性乳腺癌的临床病理特征及预后因素分析

Clinicopathological characteristics and prognosis of triple-negative breast cancer： 61 cases

目的探讨三阴性乳腺癌（tripl enegative breast cancer，TNBC）的临床病理特征、复发转移模式和生存情况，分析影响TNBC预后的相关因素。方法对从2008年1月至2011年12月在浙江中医药大学附属温州市中医院外科治疗的378例乳腺癌患者进行回顾分析，根据免疫组化染色检测结果分为三阴性乳腺癌组（61例，TNBC组）和非三阴性乳腺癌组（317例，non-TNBC），比较2组在临床病理特征、预后生存之间的差异性。结果与non-TNBC组患者相比，TNBC组在初诊年龄〈35岁、乳腺癌家族史、肿瘤最大径〉5cm、术前腋窝淋巴结状态阳性、肿瘤临床分期为Ⅲ期、组织学分级为Ⅲ级、Ki67及P53阳性过表达等方面异性有显著统计学意义（P均〈0．05），而在发病月经状态、病理类型和手术方式等方面2者差异无统计学意义。TNBC组的局部复发和远处转移率均高于non—TNBC组。TNBC组的5年无病生存率（diseasefree survival，DFS）和总生存率（overall survival，OS）均明显低于non-TNBC组。通过单因素分析发现影响TNBC组5年DFS的因素为：初诊年龄、肿瘤最大径、术前腋窝淋巴结状态、肿瘤临床分期、P53阳性过表达：而影响TNBC组5年0S的单因素为：肿瘤最大径、术前腋窝淋巴结状态、肿瘤临床分期。影响TNBC组5年DFS的独立因素为：初诊年龄、肿瘤最大径、术前腋窝淋巴结状态；影响TNBC组5年OS的独立因素为：肿瘤最大径、术前腋窝淋巴结状态。结论TNBC的临床病理特征包括：发病年龄较年轻、有乳腺癌家族聚集现象、肿瘤最大径较大、术前腋窝淋巴结状态阳性多、肿瘤临床分期偏晚、组织学分级较高，易局部复发和远处转移，5年DFS和5年OS均较低；此外，患者的初诊年龄、肿瘤最大径、术前腋窝淋巴结状态、肿瘤临床分期、P53阳性过表达对判断其预后具有重要的临床意义。

Objective To explore the clinicopathological characteristics, recurrence, metastasis and survival of triple negative breast cancer （TNBC）, and to analyze the correlation factors affecting the prognosis. Methods Data of 378 breast cancer patients treated from Jan. 2008 to Dec. 2011 were retrospectively analyzed. According to immunohistochemical staining of estrogen of receptor （ER）, progesterone receptor （PR） and human epidermal growth factor receptor 2 （HER2）, they were divided into TNBC group （61 cases） and non-triple negative breast cancer group （non-TNBC, 317 cases）. The two groups were compared in terms of clinicopathological characteristics, prog- nosis and survival. Results Patients in TNBC group had significant differences in the following aspects： ratio of patients with newly diagnosed age 〈35 years old, patients with family history of breast cancer, the maximum diameter of tumor more than 5 era, positive preoperative axillary lymph node status, tumor in clinical stage Ⅲ, histological grade of tumor in level Ⅲ, Ki67 overexpression and P53 overexpression,while there was no statistical difference in the aspects of menstrual status, pathological type or surgical method between them. The local recurrence and distant metastasis rate were obviously higher in TNBC group than in non-TNBC group. 5-year disease-free survival （DFS） and 5-year overall survival （OS） were significantly lower in TNBC group than in non-TNBC group. Univariate analysis showed that factors related to 5-year DFS in TNBC group were： age, the maximum diameter of tumor, the preoperative axillary lymph node status, clinical staging of tumor, and P53 overexpression. The maximum diameter of tumor, the preoperative axillary lymph node status and clinical staging of tumor were recognized as the influence factors of 5-year OS. Independent factors affecting 5-year DFS in TNBC group were： the maximum diameter of tumor, and the preoperative axillary lymph node status. The maximum diameter of tu- mor and the preoperative axillary lymph node status were the independent factors influencing 5-year OS. Conclusions The clinicopathological characteristics of TNBC include： younger onset age, family clustering of breast cancer, the larger maximum of tumor diameter, larger portion of positive preoperative axillary lymph node, later clinical staging of tumor, higher histological grade of tumor, easier local recurrence and distant metastasis, lower 5-year DFS and 5-year OS. The factors of age, the maximum diameter of tumor, the preoperative axillary lymph node status, clinical staging of tumor, P53 overexpression especially the maximum diameter of tumor and the preoperative axillary lymph node status play the important clinical roles in judging the prognosis of TNBC.