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Ⅰ~Ⅲ期三阴性乳腺癌病人接受保乳手术或乳房切除术的预后分析

Prognostic analysis of breast⁃conserving surgery or mastectomy in patients with stageⅠ-Ⅲtriple⁃negative breast cancer
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摘要 目的:探讨Ⅰ~Ⅲ期三阴性乳腺癌(triple⁃negative breast cancer,TNBC)病人接受保乳手术(breast⁃con⁃serving surgery,BCS)或乳房切除术(mastectomy,M)对病人无病生存(disease free survival,DFS)和总生存(overall sur⁃vival,OS)的影响。方法:收集2009年1月至2018年12月上海交通大学医学院附属瑞金医院乳腺疾病诊治中心收治的844例可手术Ⅰ~Ⅲ期TNBC病人,根据手术方式分为BCS组和M组。采用COX回归分析评估病人的临床特征和手术方式对病人DFS和OS的影响。进一步应用倾向性评分匹配平衡两组病人间存在的基线特征差异,评估两组手术的预后差异。结果:533例(63.15%)接受M,311例(36.85%)接受BCS。与M组相比,年轻、肿瘤小、淋巴结阴性、HER2表达缺失(HER2⁃0)的病人更多接受BCS。中位随访时间72个月。多因素分析表明,M组病人的OS率低于BCS组病人(HR=2.02,95%CI:1.04~3.91,P=0.038),但两组DFS差异无统计学意义(HR=1.42,95%CI:0.94~2.15,P=0.100)。将病人T分期、N分期(pN)和年龄等因素进行倾向性评分匹配平衡后,BCS组和M组病人OS率(P=0.114)和DFS率(P=0.124)差异无统计学意义。结论:在Ⅰ~Ⅲ期TNBC病人中,年轻、肿瘤小、淋巴结阴性和HER2⁃0病人更多选择BCS。匹配相关临床病理指标后,TNBC病人接受BCS或M手术方式的预后差异无统计学意义。 Objective:To investigate the effect of breast⁃conserving surgery(BCS)or mastectomy(M)in patients with stageⅠ-Ⅲtriple⁃negative breast cancer(TNBC)on disease free survival(DFS)and overall survival(OS).Methods:A total of 844 patients with stageⅠ-ⅢTNBC who were admitted to Comprehensive Breast Health Center,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from January 2009 to December 2018 were collected and divided into BCS and M groups according to the surgical method.COX regression analysis was used to evaluate the influence of clinical characteristics and surgical methods on DFS and OS of the patients.The propensity score was further used to balance the differences in baseline characteristics between the two groups of patients,and to evaluate the differences in the prognosis of two groups of patients.Results:There were 533 patients(63.15%)underwent M and 311 patients(36.85%)underwent BCS.Patients with younger age,smaller tumor size,negative lymph node,and loss of HER2 expression(HER2⁃0)were more tend to BCS group compared to M group.Median follow⁃up time was 72 months.Multivariate COX analysis showed that the OS of M group was lower than that of BCS group(HR=2.02,95%CI:1.04-3.91,P=0.038),but there was no sig⁃nificant difference in DFS between the two groups(HR=1.42,95%CI:0.94-2.15,P=0.100).After propensity score match⁃ing for factors such as T stage,N stage and age,the results showed that there was no significant difference in OS(P=0.114)and DFS(P=0.124)between BCS and M groups.Conclusions:Among patients with stageⅠ-ⅢTNBC,patients with Surg Concepts Pract 2023,Vol.28,No.4 younger age,smaller tumor,negative lymph node,and HER2⁃0 were more likely to choose BCS.After propensity score matching for relevant clinicopathological parameters,the results indicated that there was no significant difference in OS and DFS of the TNBC patients undergoing BCS or M surgery.
作者 朱巧俐 苗伊鸣 陈小松 ZHU Qiaoli;MIAO Yiming;CHEN Xiaosong(Department of Breast and Tyroid Surgery,Quzhou Affiliated Hospital of Wenzhou Medical University,Quzhou People's Hos-pital,Zhejiang Quzhou 324000,China;Department of General Surgery,Comprehensive Breast Health Center,Ruijin Hospi-tal,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处 《外科理论与实践》 2023年第4期371-377,共7页 Journal of Surgery Concepts & Practice
关键词 乳腺癌 三阴性 保乳手术 乳房切除术 Breast cancer Triple⁃negative Breast⁃conserving surgery Mastectomy
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