不同分子分型乳腺癌患者临床病理特征及预后因素分析

Analysis of clinicopathological features and prognostic factors of breast cancer patients with different molecular subtypes

目的探讨不同分子分型乳腺癌患者临床病理特征、生存情况及预后影响因素的差异,为乳腺癌的防治提供依据。方法回顾性分析2015年1月至2016年12月在山西省肿瘤医院住院的新发女性乳腺癌患者临床病理资料,对患者进行随访。比较不同分子分型患者临床病理特征。随访截至2021年6月30日。采用Kaplan-Meier法分析患者生存情况,采用Cox比例风险模型分析不同分子分型患者总生存(OS)影响因素。结果Luminal A型、Luminal B型、人类表皮生长因子受体2(HER2)过表达型和三阴性乳腺癌(TNBC)患者分别为272例(14.9%)、1005例(55.2%)、277例(15.2%)、268例(14.7%)。4组间患者诊断年龄、初潮年龄、绝经状态、绝经年龄、病理类型、肿瘤长径、T分期、N分期,组织学分级、TNM分期分布差异均有统计学意义(均P<0.05)。中位随访60个月,Luminal A型、Luminal B型、HER2过表达型和TNBC患者的5年OS率分别为93.8%、89.2%、77.6%和78.0%,差异有统计学意义(χ^(2)=58.76,P<0.001)。M分期是Luminal A型乳腺癌患者OS独立影响因素(HR=16.789,95%CI 4.972~56.690,P<0.001),T分期(HR=2.721,95%CI 1.715~4.319)、N分期(HR=4.460,95%CI 2.399~8.291)、M分期(HR=3.364,95%CI 1.988~6.670)是Luminal B型乳腺癌患者OS独立影响因素(均P<0.001),N分期(HR=4.428,95%CI 1.836~10.677)、M分期(HR=13.489,95%CI 6.043~30.107)是HER2过表达型乳腺癌患者OS独立影响因素(均P<0.01),T分期(HR=3.052,95%CI 1.575~5.915)、N分期(HR=2.492,95%CI 1.298~4.785)、M分期(HR=33.012,95%CI 8.606~126.637)是TNBC患者OS独立影响因素(均P<0.01)。结论不同分子分型乳腺癌患者临床病理特征及预后影响因素不同,HER2过表达型和TNBC患者的预后较差。针对不同分子分型乳腺癌患者,临床医师应提供个体化治疗和随访方案。

Objective To explore the differences in clinicopathological features,survival status and prognostic influencing factors of breast cancer patients with different molecular subtypes,and to provide bases for the prevention and treatment of breast cancer.Methods The clinicopathological data of new-onset female breast cancer patients hospitalized in Shanxi Province Cancer Hospital from January 2015 to December 2016 were retrospectively analyzed,and patients were followed up.The clinicopathological features of patients with different molecular subtypes were compared.The follow-up was performed until June 30,2021.Kaplan-Meier method was used to analyze the survival of patients,and Cox proportional hazards model was used to analyze the factors affecting overall survival(OS)of patients with different molecular subtypes.Results There were 272(14.9%),1005(55.2%),277(15.2%)and 268(14.7%)patients with subtypes of Luminal A,Luminal B,human epidermal growth factor receptor 2(HER2)overexpression and triple-negative breast cancer(TNBC),respectively.The differences in the distribution of patients with age at diagnosis,age at menarche,menopausal status,age at menopause,pathological type,longest tumor diameter,T staging,N staging,histological grading,and TNM staging were statistically significant among the four groups(all P<0.05).At a median follow-up of 60 months,the 5-year OS rates of Luminal A,Luminal B,HER2 overexpression and TNBC subtypes were 93.8%,89.2%,77.6%and 78.0%,respectively,and the difference was statistically significant(χ^(2)=58.76,P<0.001).M staging was an independent influencing factor for OS in patients with Luminal A breast cancer(HR=16.789,95%CI 4.972-56.690,P<0.001);T staging(HR=2.721,95%CI 1.715-4.319),N staging(HR=4.460,95%CI 2.399-8.291)and M staging(HR=3.364,95%CI 1.988-6.670)were independent influencing factors for OS in patients with Luminal B breast cancer(all P<0.001);N staging(HR=4.428,95%CI 1.836-10.677)and M staging(HR=13.489,95%CI 6.043-30.107)were independent influencing factors for OS of patients with HER2 overexpression breast cancer(both P<0.01);T staging(HR=3.052,95%CI 1.575-5.915),N staging(HR=2.492,95%CI 1.298-4.785)and M staging(HR=33.012,95%CI 8.606-126.637)were independent influencing factors for OS of patients with TNBC(all P<0.01).Conclusions The clinicopathological features and prognostic influencing factors of breast cancer patients with different molecular subtypes are different,and the prognosis of HER2 overexpression and TNBC patients is poor.Clinicians should provide individualized treatment and follow-up programs for patients with different molecular subtypes of breast cancer.