乳腺癌根治术患者化疗相关粒细胞减少与预后的关系

Prognostic Value of Chemotherapy-Induced Neutropenia in Patients with Breast Cancer Surgery

目的探讨乳腺癌患者相关粒细胞减少(CIN)与预后的关系。方法选取2010年9月5日至2011年12月29日中国医科大学附属第一医院乳腺外科327例Ⅰ~Ⅲ期乳腺癌患者,患者均进行根治性手术和化疗,记录患者年龄、病理类型、肿物大小、淋巴结转移、HER-2表达、分期、术式、化疗方案等临床指标;对出现CIN患者与未出现CIN患者的无病生存期进行分析,并对预后因素进行Cox回归分析。结果327例患者中,162例(49.5%)患者发生CIN,与未出现CIN患者比较,出现CIN患者具有更好预后(χ^2=4.022,P=0.045)。198例激素受体阳性患者中,出现CIN患者无病生存期显著高于未出现CIN患者(χ^2=9.951,P=0.002)。Cox回归分析显示,CIN不能作为乳腺癌的独立预后因素(P=0.203),但Ⅲ~Ⅳ度CIN可能作为相对独立的预后因素。结论CIN提示乳腺癌患者预后良好,Ⅲ~Ⅳ度CIN对于预后具有更强的提示作用。

Objective The aim of the study was to investigate the prognostic value of chemotherapy-induced neutropenia(CIN)in patients with breast cancer.Methods Patients with stageⅠ-Ⅲbreast cancer who were admitted to the First Hospital of China Medical University between 5 September 2010 and 29 December 2011 were enrolled in our study based on predefined inclusion and exclusion criteria.The disease-free survival(DFS)rate of patients with and without CIN was compared.Additionally,patients were divided into hormone receptor(HR)-positive and HR-negative groups;the DFS rate of patients with and without CIN in the HR-positive and HR-negative groups was compared.Cox proportional hazards regression analyses were used to compare the survival rates with clinical and pathologic factors.Results Of 327 patients,CIN occurred in 162(49.5%)patients;these patients had a better prognosis compared with those without CIN(P=0.045).Moreover,patients with gradeⅢ-ⅣCIN had a better prognosis than patients without CIN(P=0.013).Of the 198 HR-positive patients,the DFS rate was significantly higher in patients with CIN than patients without CIN(P=0.002).Conclusion CIN is a good predictor of prognosis,especially gradeⅢ-ⅣCIN may be regarded as an independent prognostic factor in patients with breast cancer.