摘要
目的探讨乳腺癌患者自疾病诊断至手术治疗之间的时间间隔对患者预后的影响。方法采用回顾性研究方法,纳入2012年4月—2014年8月在西安交通大学第二附属医院行乳腺癌诊断和治疗的252例女性患者,平均年龄(58.2±10.8)岁,范围31~67 岁。收集患者的一般人口学信息和临床肿瘤资料,术后采用门诊或电话随访方式收集乳腺癌患者的术后5年复发、转移、死亡以及无病生存状态信息。根据诊断到治疗之间的时间间隔<2 周、2~4 周、4~8 周、≥8 周将研究对象分为4 组,分别为26、118、78和30 例。另外,根据乳腺癌肿瘤直径(<20 mm、20~40 mmm、≥40 mm)将研究对象分为3组,分别为99、124、29例。根据对术中解剖获取的淋巴结所进行的病理检查结果,将研究对象分为淋巴结无转移、1~3枚转移、≥3枚转移,分别为66、124、62例。采用Cox比例回归风险模型评估治疗前时间间隔与乳腺癌患者死亡风险比(HR)及其95%CI,校正年龄、教育程度和体重指数。并进一步根据患者的肿瘤特征,包括病理类型、组织学分级、肿瘤直径、淋巴结转移和受体表达情况分层分析治疗前时间间隔与乳腺癌患者死亡风险之间的关联性。采用Kaplan-Meier生存曲线评估治疗前不同时间间隔对患者预后生存的影响。结果 4 组乳腺癌患者术后5 年总生存期的Kaplan-Meier生存曲线差异具有统计学意义(P<0.001),且治疗前时间间隔<2 周的患者生存时间最长,而≥8 周的患者生存时间最短。随着治疗前时间间隔延长1 周,乳腺癌总死亡风险增加6%(HR=1.06,95%CI:1.01~1.11),乳腺癌死亡风险增加8%(HR=1.08,95%CI:1.02~1.14),乳腺癌细胞远处转移风险增加10%(HR=1.10,95%CI:1.08~1.13)。随着乳腺癌肿瘤直径的增加(<20 mm、20~40 mm、≥40 mm),患者治疗时间前间隔的延长所导致的总死亡风险呈现递增趋势,HR值(95%CI)分别为1.06(1.03~1.09)、1.08(1.02~1.12)和1.11(1.05~1.17)。随着乳腺癌淋巴结转移程度的增加(无转移、1~3 枚转移,≥3 枚转移),患者治疗时间前间隔的延长所导致的总死亡风险也呈现递增趋势,HR值(95%CI)分别为1.04(1.02~1.08)、1.06(1.04~1.08)和1.08(0.99~1.11)。相同的结果也体现在肿瘤直径或远处淋巴结转移对治疗时间间隔与乳腺癌生存期和乳腺癌细胞远处转移之间关联性的影响。结论随着乳腺癌患者自疾病诊断至手术治疗之间的时间间隔的延长,患者术后死亡风险显著提高,且该关联性在肿瘤较大或远处淋巴结转移程度较高的人群中更为明显。
Objective To investigate the effect of time interval between diagnosis and surgical treatment on the prognosis of breast cancer. Methods A retrospective study that include a total of 252 female patients who underwent breast cancer diagnosis and treatment in the Second Affiliated Hospital of Xi'an Jiaotong University from April 2012 to August 2014 were included in the present study, the average age was (58.2±10.8) years old, range from 31 to 67 years old. General demographic information and data of tumor were collected. Information on postoperative recurrence, metastasis, death, and disease-free survival status of breast cancer patients were followed up 5 years by outpatient follow-up or telephone follow-up. All participants were divided into four groups (<2 weeks, 2-4 weeks, 4-8 weeks,≥8 weeks) by the time interval between diagnosis and surgical treatment, including 26, 118, 78 and 30 cases, respectively. In addition, according to the diameter of breast cancer tumors, all participants were divided into three groups (<20 mm, 20-40 mm, and ≥40 mm), including 99, 124, and 29 cases, respectively. According to the results of pathological examination of the lymph nodes obtained during intraoperative dissection, the all participants were divided into three groups (lymph nodes without metastasis, 1 to 3 metastasis, and ≥3 metastasis), including 66, 124, and 62 cases, respectively. The Cox proportional regression risk models were used to assess the hazard ratio (HR) and its 95% confidence interval (CI) of time interval between diagnosis and surgical treatment with the prognosis of breast cancer, with adjustment for age, education levels and body mass index. Further, stratified analysis by tumor characteristics, including pathological type, histological grade, tumor diameter, lymph node metastasis, and receptor expression were also conducted to evaluated the above association. Kaplan-Meier survival curve was used to evaluate the effects of time interval between diagnosis and surgical treatment on the prognosis of breast cancer. Results The Kaplan-Meier survival curves for the five-year follow-up of total survival time between 4 different time intervals groups showed significantly different (P<0.001), and patients with a pre-treatment interval of <2 weeks had the longest survival time, while those with ≥8 weeks had the lowest survival time. With a one-week interval before treatment, the overall risk of death in breast cancer patients increased by 6%(HR=1.06, 95%CI: 1.01-1.11), and the risk of breast cancer death increased by 8%(HR=1.08, 95%CI: 1.02-1.14), the risk of distant metastasis of breast cancer cells increased by 10%(HR=1.10, 95%CI: 1.08-1.13). With the increase in breast cancer tumor diameter (<20 mm, 20-40 mm,≥40 mm), the overall risk of death due to prolonged treatment interval increased gradually, with HR (95%CI) were 1.06 (1.03-1.09), 1.08 (1.02-1.12) and 1.11 (1.05-1.17), respectively. With the increase of lymph node metastasis in breast cancer (no metastasis, metastasis at 1-3,≥3 metastasis), the total mortality risk caused by prolonged treatment time interval also showed an increasing trend, with HR (95%CI) were 1.04 (1.02-1.08), 1.06 (1.04-1.08) and 1.08 (0.99-1.11), respectively. The same results were also shown in the effect of tumor diameter or distant lymph node metastasis on the association between treatment time interval and breast cancer survival and distant metastasis of breast cancer cells. Conclusion With the prolongation of the time interval between the diagnosis of the breast cancer and the surgical treatment of breast cancer patients, the risk of postoperative death is significantly increased, and the association is more pronounced in breast cancer patients with larger tumor volume or higher distant lymph node metastasis.
作者
张心武
张寅斌
张迪
李顺乐
孙晓力
雷焕芹
翟宏军
Zhang Xinwu;Zhang Yinbin;Zhang Di;Li Shunle;Sun Xiaoli;Lei Huanqin;Zhai Hongjun(Department of General Surgery, Second Affiliated Hospital of Xi′an Jiaotong University, Xi′an 710004, China;Department of Oncology, Second Affiliated Hospital of Xi′an Jiaotong University, Xi′an 710004, China)
出处
《国际外科学杂志》
2019年第5期334-339,共6页
International Journal of Surgery
关键词
乳腺肿瘤
无病生存
淋巴转移
肿瘤直径
Breast neoplasms
Disease-free survival
Lymphatic metastasis
Neoplasm diameter