pT1N0M0期Luminal B样乳腺癌的治疗及预后分析

Treatment and prognosis of pT_1N_0M_0 Luminal B-like breast cancer

目的 :分析pT_1N_0M_0期Luminal B样乳腺癌的临床病理特征、治疗方法及预后情况。方法 :收集2010年1月—2013年1月于天津医科大学肿瘤医院行手术治疗的300例pT_1N_0M_0期Luminal B样乳腺癌患者的资料。采用χ~2检验进行临床病理资料之间的比较,Kaplan-Meier法分析患者的生存情况,log-rank检验行单因素分析,COX比例风险回归模型进行预后的多因素分析。结果 :300例pT_1N_0M_0期Luminal B样乳腺癌患者中,p T1aN0M0期24例(8%),p T1bN0M0期115例(38.3%),p T1cN0M0期161例(53.7%)。χ~2检验分析结果显示,组织学分级与肿瘤大小相关(P=0.004)。单因素分析结果显示,发病年龄、组织学分级、人表皮生长因子受体2(human epidermal growth factor receptor-2,HER-2)表达、增殖细胞核相关抗原Ki-67阳性标记指数及化疗对患者的5年无疾病生存率有影响(P值均<0.05);HER-2表达状态与患者的5年总生存率相关(P<0.05)。多因素分析显示,组织学分级(P=0.048)、是否化疗(P=0.046)、HER-2表达状态(P=0.001)和Ki-67高低(P=0.002)是影响患者5年无病生存率的独立因素。进一步分析化疗方案与预后的关系,结果显示紫杉类/蒽环类单药化疗组与紫杉类联合蒽环类化疗组相比,p T1_(a-b)N_0M_0期患者的5年无病生存率和总生存率无明显差异(P值均>0.05),而p T1cN0M0期患者紫杉类联合蒽环类化疗组的5年无病生存率明显优于紫杉类/蒽环类单药化疗组(P=0.042),但5年总生存率无明显差异(P=0.711)。结论 :术后辅助化疗可以改善pT_1N_0M_0期Luminal B样乳腺癌患者的预后。对p T1_(a-b)N_0M_0期患者可以给予紫杉类/蒽环类单药为主的化疗方案,而对pT1cN0M0期患者给予紫杉类联合蒽环类方案化疗预后更好。

Objective： To analyze the clinicopathological characteristics,treatment and prognosis of Luminal B-like breast cancer in pT_1N_0M_0 stage.Methods： The data of 300 patients with stage pT_1N_0M_0 Luminal B-like breast cancer who underwent surgery in Tianjin Medical University Cancer Institute and Hospital from January2010 to January 2013 were collected. The clinicopathological characteristics, treatment and prognosis were retrospectively analyzed by using the statistical methods such as χ~2 test,univariate analysis, COX multivariate analysis, Kaplan-Meier and so on.Results： In 300 cases of breast cancer, there were 24 cases（8%） in pT_（1a）N_0M_0 stage, 115 cases（38.3%） in pT1 bN0 M0 stage, and 161 cases（53.7%） in pT1 cN0 M0 stage. Intergroup analysis（χ~2 test） showed that only histological grade was related to tumor size（P = 0.004）. Univariate analysis showed that age, histological grade, human epidermal growth factor receptor-2（HER-2） expression, Ki-67 expression and chemotherapy had an effect on the five-year disease-free survival（DFS） of patients（all P〈0.05）, and HER-2 was associated with five-year overall survival（OS） rate（P〈0.05）. Multivariate analysis showed that histological grade（P =0.048）, chemotherapy（P = 0.046）, HER-2（P = 0.001） status and Ki-67 expression（P = 0.002）were independent factors of five-year DFS rate of the patients. The relationship between chemotherapy regimens and prognosis was further analyzed, and the results showed that five-year DFS rate and OS rate of the patients in pT_（1a-b）_N_0M_0 stage had no significant difference between taxane/anthracycline alone chemotherapy group and taxane combined with anthracycline group（both P〈0.05）. For the patients in pT_1cN_0M_0, the five-year DFS rate in taxane combined with anthracycline chemotherapy group was significantly higher than that in taxane/anthracycline alone chemotherapy group（P = 0.042）, but the five-year OS rate was not significant different between the two groups（P = 0.711）.Conclusion： Postoperative adjuvant chemotherapy can improve the prognosis of patients with stage pT_1N_0M_0 Luminal B-like breast cancer. The patients in pT_（1a-b）_N_0M_0 stage may be given taxanes/anthraquinones chemotherapy for reducing overtreatment. For the patients in pT_1cN_0M_0 stage, the prognosis will be better when the taxane combined with anthracycline chemotherapy is given.