基于SEER数据库的早期乳腺恶性分叶状肿瘤预后相关因素分析

Analysis of prognostic factors of early breast malignant phyllodes tumor based on SEER database

目的基于监测、流行病学和最终结果(SEER)数据库探讨影响早期乳腺恶性分叶状肿瘤预后的相关因素。方法回顾性分析2000年至2015年SEER数据库内有完整数据记录的早期乳腺恶性分叶状肿瘤病例,统计分析患者总生存期的影响因素,采用Kaplan-Meier法及Cox回归模型分析手术与放疗对Ⅰ~Ⅱ期患者预后的影响。结果共835例患者纳入本研究,中位发病年龄为52岁。针对Ⅰ~Ⅱ期患者的亚组分析发现,单因素分析提示年龄≥70岁(HR=2.32,95%CI:1.17~4.61,P=0.02)、低分化及未分化(HR=2.49,95%CI:1.52~4.08,P<0.01)的早期乳腺恶性分叶状肿瘤患者预后相对更差,乳房全切术组预后差于保乳术组(HR=4.36,95%CI:2.55~7.46,P<0.01),术后放疗组预后比不放疗组差(HR=1.86,95%CI:1.08~3.22,P=0.03)。多因素分析显示,Ⅰ~Ⅱ期患者中乳房全切术组患者预后差于保乳术组患者(HR=3.39,95%CI:1.93~5.97,P<0.01)。结论早期乳腺恶性分叶状肿瘤患者的局部治疗推荐保乳术,术后放疗并不能带来生存获益。

Objective To explore the prognostic factors of early breast malignant phyllodes tumor based on Surveillance,Epidemiology and End Results(SEER)database.Methods A retrospective analysis was made on the cases of early breast malignant phyllodes tumor with complete data records in SEER database from 2000 to 2015.The influence factors of overall survival were statistically analyzed.Kaplan-Meier estimator and Cox regression model were used to analyze the effect of surgery and radiotherapy on the prognosis of stageⅠ-Ⅱpatients.Results A total of 835 patients were included in this study.The median age of onset was 52 years old.Univariate analysis of stageⅠ-Ⅱpatients showed that patients with age≥70 years old(HR=2.32,95%CI:1.17-4.61,P=0.02)and low dedifferentiation and undifferentiation(HR=2.49,95%CI:1.52-4.08,P<0.01)had worse prognosis.The prognosis of total mastectomy group was worse than that of breast-conserving therapy group(HR=4.36,95%CI:2.55-7.46,P<0.01).The prognosis of postoperative radiotherapy group was worse than that of non-radiotherapy group(HR=1.86,95%CI:1.08-3.22,P=0.03).Multivariate analysis showed that the prognosis of total mastectomy group was worse than that of breast conserving group(HR=3.39,95%CI:1.93-5.97,P<0.01).Conclusion The local treatment of early stage breast cancer patients is recommended to receive breast-conserving therapy,and postoperative radiotherapy does not bring survival benefits.