T_(1～2)N_1M_0期乳腺癌患者5年预后的影响因素分析

Prognostic factors for 5-year survival of patients with T_(1-2)N_1M_0 breast cancer

目的分析影响T_(1～2)N_1M_0期乳腺癌患者5年预后的因素。方法比较180例术后接受放疗和19例未接受放疗(共199例)T_(1～2)N_1M_0期伴1～3枚淋巴结转移乳腺癌患者的5年累积总生存(OS)率、无进展生存(PFS)率及无局部/区域复发生存(LRFS)率。采用Kaplan-Meier法绘制生存曲线,Cox比例风险回归模型分析5年预后的影响因素。结果不同激素受体状态、HER2状态、清扫淋巴结数目、术后是否放疗乳腺癌患者的累积OS率比较,差异均有统计学意义(P﹤0.05);不同激素受体状态、HER2状态、有无淋巴管受侵、术后是否放疗乳腺癌患者的累积PFS率比较,差异均有统计学意义(P﹤0.05);有无淋巴管受侵、术后是否放疗乳腺癌患者的累积LRFS率比较,差异均有统计学意义(P﹤0.05)。将上述变量分别纳入Cox比例风险模型进行分析,结果显示,激素受体状态、术后放疗、HER2状态是OS的影响因素(P﹤0.05);激素受体状态、淋巴管受侵、术后放疗是PFS的影响因素(P﹤0.05);术后放疗是LRFS的影响因素(P﹤0.01)。不同年龄、激素受体状态、HER2状态、T分期、阳性淋巴结比例、转移淋巴结数目、有无淋巴管受侵、清扫淋巴结数目、是否新辅助化疗、是否化疗的放疗患者的5年累积LRFS率比较,差异均无统计学意义(P﹥0.05)。结论术后放疗是T_(1～2)N_1M_0期伴1～3枚淋巴结转移的乳腺癌患者远期OS、PFS、LRFS的影响因素;术后放疗不仅可降低患者的局部复发率,还可提高患者的长期生存率。

Objective To evaluate the prognostic factors affecting the 5-year survival in patients with stage T1-2N1M0 breast cancer. Method The 5-year cumulative overall survival (OS) rate, progression-free survival (PFS) rate and local/ regional recurrence-free survival (LRFS) rate were compared between 180 cases received postoperative radiotherapy and 19 cases without postoperative radiotherapy (199 cases) patients with stage T1- 2N1M0 breast cancer and 1- 3 metastatic lymph nodes. Kaplan-Meier survival curve was drawn and Cox proportional hazard regression model was used to analyze the influencing factors of 5-year prognosis. Result The state of hormone receptor, HER2 status, number of dissected lymph nodes and postoperative radiotherapy were related to cumulative OS rate in patients with breast cancer, with statistically significant differences observed (P<0.05);the state of hormone receptor, HER2 status, lymphatic vessel invasion and postoperative radiotherapy were associated with cumulative PFS rate in patients with breast cancer (P<0.05);additionally, lymphatic vessel invasion and postoperative radiotherapy were linked with cumulative LRFS rate in patients with breast cancer (P<0.05). The variables were included in Cox proportional hazard model, and it was found that, hormone receptor status, postoperative radiotherapy and HER2 status were factors influencing the OS of patients (P<0.05);hormone receptor status, lymphatic vessel invasion, and postoperative radiotherapy were factors affecting PFS (P<0.05);while postoperative radiotherapy was an independent prognostic factor for LRFS (P<0.01). Lastly, age, hormone receptor status, HER2 status, T stage, ratio of positive lymph nodes, number of metastatic lymph nodes, presence of lymphatic vessel invasion, number of dissected lymph nodes , neoadjuvant chemotherapy, and administration of chemotherapy were independent from the 5- year cumulative LRFS, with no statistically significant difference observed (P>0.05). Conclusion Postoperative radiotherapy is an independent prognostic factor for the long-term OS, PFS, LRFS rates in T1-2N1M0 breast cancer patients. Postoperative radiotherapy can not only reduce the local recurrence rate of patients, but also improve the long-term survival rate of patients.