基于SEER数据库分析三阴性炎性乳腺癌的预后因素

Prognostic factors of triple-negative inflammatory breast cancer based on SEER database

目的探讨三阴性炎性乳腺癌(TNIBC)患者的临床病理特征及生存预后因素。方法从SEER数据库获取2010年至2015年TNIBC患者的病例,利用R统计软件中“survival”包进行单因素分析、多因素分析及Kaplan-Meier生存分析。结果共收集炎性乳腺癌病例4268例,其中TNIBC 1023例。与非TNIBC患者相比,TNIBC患者中白人占比较低,组织学分级倾向Ⅲ级,AJCC分期Ⅲ期占比较高,未发生远处转移者更多,更容易接受化疗(P<0.05)。单因素Cox分析显示,偏侧性、肿瘤直径、AJCC分期、M分期、手术和化疗可能是总生存期(OS)的影响因素(P<0.05)。多因素Cox分析显示,偏侧性、肿瘤直径和手术是TNIBC患者OS的独立影响因素,且肿瘤直径越小[28~989 mm,HR=1.565,95%CI:1.061~2.309,P=0.024;>989 mm,HR=1.911,95%CI:1.205~3.030,P=0.006]、居于右侧(HR=0.719,95%CI:0.560~0.923,P=0.010)、手术治疗(HR=0.609,95%CI:0.423~0.876,P=0.008)与更好的预后相关。结论偏侧性、肿瘤直径和手术是影响TNIBC患者生存预后的独立因素,且肿瘤小、居于右侧、手术治疗与更好的预后相关。

Objective To investigate the clinicopathological features and survival prognostic factors of patients with triple-negative inflammatory breast cancer(TNIBC).Methods The data of patients with TNIBC from 2010 to 2015 were obtained from SEER database,and univariate analysis,multivariate analysis and Kaplan-Meier survival analysis were performed using the“survival”package in R statistical software.Results A total of 4268 cases of inflammatory breast cancer were collected,including 1023 cases of triple-negative subtype.Compared with non-TNIBC patients,TNIBC patients had a lower proportion of whites in ethnic distribution,a higher proportion of histological gradeⅢ,a higher proportion of AJCC stageⅢ,and more patients without distant metastases,and more likely to receive chemotherapy(P<0.05).Univariate Cox analysis showed that laterality,tumor diameter,AJCC stage,M stage,surgery and chemotherapy may be the influencing factors of overall survival(OS)(P<0.05).Multivariate Cox analysis showed that laterality,tumor diameter and surgery were independent risk factors for OS in TNIBC patients,and the smaller the tumor(28-989 mm,HR=1.565,95%CI:1.061-2.309,P=0.024;>989 mm,HR=1.911,95%CI:1.205-3.030,P=0.006),locating in the right side(HR=0.719,95%CI:0.560-0.923,P=0.010),and the surgical treatment(HR=0.609,95%CI:0.423-0.876,P=0.008)were associated with better prognosis.Conclusion Laterality,tumor diameter,and surgery are independent influencing factors for survival prognosis in patients with TNIBC,and the smaller the tumor,locating in the right side,and surgery are associated with better prognosis.