乳腺癌化疗脑与病理特征的关系及其对预后的影响研究

Research on the relationship between chemobrain and pathological features and its influence on prognosis of patients suffered with breast cancer

目的分析乳腺癌化疗脑与病理特征的关系及其对预后的影响。方法回顾性分析2015年5月—2018年5月在本院确诊的226例拟行手术治疗乳腺癌患者的临床资料,所有患者均接受至少4个周期化疗,随访化疗脑发生情况,比较化疗脑组与非化疗脑组的相关因素并进行多因素Logistic回归分析,采用Kaplan-Meyer生存曲线,观察化疗脑发生与无瘤生存率的关系。结果所有患者均获得随访,中位随访时间为化疗后24.5个月(13-36个月),共有68例患者(30.09%)诊断为化疗脑。化疗脑组与非化疗脑组在年龄、绝经发生率、ER阳性率、PR阳性率、临床病理分期、化疗周期、腋窝淋巴结转移率上比较,差异均有统计学意义(P<0.05);经多因素Logistic回归分析,年龄、ER阴性、PR阴性和Ⅲ期均是乳腺癌化疗脑的独立危险因素(P<0.05);化疗脑组病理完全缓解率为82.35%,明显低于非化疗脑组的98.10%,差异有统计学意义(P<0.05);化疗脑组中有6例患者发生局部复发或转移,非化疗脑组中有4例患者发生局部复发或转移,经Kaplan-Meyer生存曲线分析,化疗脑组3年累计无瘤生存率为91.2%,明显低于非化疗脑组的97.5%,差异有统计学意义(χ^(2)=28.754,P=0.000);不同危险因素个数患者在3年累计无瘤生存率上差异有统计学意义(χ^(2)=25.463,P=0.000);有4个危险因素的患者3年累计无瘤生存率为30.8%,明显低于无危险因素的患者的95.0%,差异有统计学意义(χ^(2)=46.824,P=0.000)。结论乳腺癌化疗脑的发生与年龄、ER阴性、PR阴性和临床病理分期Ⅲ期有关,提示这部分患者的预后更差,需要更加密切的随访,以局部复发或转移能够被早期诊治。

Objective To analyze the relationship between chemobrain of patients suffered breast cancer and pathological features and its effect on prognosis.Methods From May 2015 to May 2018,226 patients diagnosed in our hospital who planned to undergo surgery to treat breast cancer were selected as the research object,all of them received at least 4 cycles of chemotherapy,the occurrence of chemobrain was followed up,compare the related factors of chemobrain group and non-chemobrain and perform multivariate logistic regression analysis,using Kaplan-Meyer survival curve to observe the relationship between chemobrain occurrence and tumor-free survival.Results All patients were followed up,with a median follow-up time of 24.5 months(13-36 months)after chemotherapy.A total of 68 patients(30.09%)were diagnosed with chemobrain.There were significant differences in age,incidence of menopause,ER positive rate,PR positive rate,clinicopathological stage,chemotherapy cycle and axillary lymph node metastasis rate between the chemobrain group and non-chemobrain group(P<0.05).Multiple Logistic regression analysis showed that age,ER negative,PR negative and stageⅢwere independent risk factors for chemobrain of breast cancer(P<0.05).The pathological complete response rate of chemobrain group was 82.35%,which was significantly lower than 98.10%of non-chemobrain group,and the difference was statistically significant(P<0.05).There were 6 cases of local recurrence or metastasis in the chemobrain group and 4 cases of local recurrence or metastasis in the non-chemobrain group.Kaplan-meyer survival curve analysis showed that the 3-year cumulative disease-free survival rate in the chemobrain group was 91.2%,which was significantly lower than that in the non-chemobrain group(97.5%),and the difference was statistically significant(χ^(2)=28.754,P=0.000).There was significant difference in 3-year cumulative disease-free survival rate among patients with different risk factors(χ^(2)=25.463,P=0.000).The 3-year cumulative disease-free survival rate of patients with 4 risk factors was 30.8%,significantly lower than that of patients without risk factors(95.0%),the difference was statistically significant(χ^(2)=46.824,P=0.000).Conclusions The occurrence of chemobrain in breast cancer is related to age,ER negative,PR negative and clinicopathological stageⅢ,suggesting that these patients have a worse prognosis and require more close follow-up,so that local recurrence or metastasis could be diagnosed and treated early.