不同分子亚型乳腺癌病人改良根治术后复发转移影响因素及时间分布研究

Influencing factors and time-distribution of recurrence and metastasis of breast cancer patients with different molecular subtypes after modified radical mastectomy

目的探讨不同分子亚型乳腺癌改良根治术后复发转移的影响因素和时间分布规律,为不同乳腺癌术后病人的治疗及随诊提供参考。方法收集338例在徐州医科大学附属医院2012年1月至2017年6月期间行改良根治术的女性乳腺癌病人相关资料,根据免疫组化结果将资料分为管腔A型(Luminal A型)、管腔B型(Luminal B型)、人类表皮生长因子受体-2过度表达型(Her-2/neu型)和BCL(basal-like breast carcinoma)型4种分子亚型,随访其复发转移情况。采用SPSS 21.0对数据进行统计分析。结果338例病人中Luminal A型、Luminal B型、Her-2/neu型和BCL型的例数分别为76例、155例、63例和44例。单因素及多因素分析结果均显示分子分型是乳腺癌术后复发转移的影响因素(P<0.05),多因素分析结果显示年龄(P=0.035)、T分期(P=0.036)是乳腺癌术后复发转移的影响因素,Her-2/neu型是乳腺癌术后复发转移的独立影响因素(P=0.020,HR=1.977),术后放疗是术后复发转移的保护性因素(P=0.004,HR=0.450)。乳腺癌术后复发转移风险呈双峰分布,复发高峰分别为术后第2年和第5年,BCL型第一个复发高峰为术后第1年。结论分子分型是乳腺癌改良根治术后复发转移的影响因素,且不同分子亚型乳腺癌改良根治术后复发转移时间有一定规律性。

Objective To explore the influencing factors and time distribution of recurrence and metastasis after modified radical mastectomy for different molecular subtypes of breast cancer,and to provide a reference for the treatment and follow-up of patients with different breast cancer after operation.Methods A Total of 338 female breast cancer patients who underwent radical mastectomy between January 2012 and June 2017 in the Affiliated Hospital of Xuzhou Medical University.According to the results of immunohistochemistry,the data were assigned into four molecular subtypes and BCL(basal-like breast carcinoma).The recurrence and metastasis were followed up.Statistical analysis was performed on the data using SPSS 21.0.Results The number of Luminal A,Luminal B,Her-2/neu and BCL in 338 patients were 76,155,63 and 44,respectively.Univariate and multivariate analysis showed that molecular typing was the influencing factor of postoperative recurrence and metastasis in breast cancer patients(P<0.05).Multivariate analysis showed that age(P=0.035)and T stage(P=0.036)were the influencing factors of postoperative recurrence and metastasis in breast cancer patients.Her-2/neu type was an independent influencing factor of postoperative recurrence and metastasis in breast cancer patients(P=0.020,HR=1.977).Postoperative radiotherapy was a protective factor affecting postoperative recurrence and metastasis(P=0.004,HR=0.450).The risk of recurrence and metastasis of breast cancer patients was bimodal,and the peak of recurrence was the second and fifth years after surgery.The first recurrence peak of BCL type was the first year after surgery.Conclusion Molecular typing is an influential factor for recurrence and metastasis after modified radical mastectomy in breast cancer patients,and there is a certain regularity in recurrence and metastasis time after modified radical mastectomy in patients with different molecular types.