年轻乳腺癌患者临床特征的研究

The clinical features of breast cancer in young patients

目的 :分析并比较年轻(<40岁)与年长(≥40岁)乳腺癌患者的临床病理特征和生存情况。方法 :研究对象为1996年8月—2011年4月在浙江大学医学院附属邵逸夫医院肿瘤外科接受治疗的1 393例乳腺癌患者,剔除年龄不详的15例患者,纳入1 378例患者(年轻患者194例,年长患者1 184例)。比较年轻与年长患者的临床病理特征和生存情况。对所有患者进行随访,失访218例。对所有患者与年轻患者的预后相关因素进行分析。结果 :年轻与年长乳腺癌患者的分子分型、T分期、N分期和保乳根治术率的差异均有统计学意义(P<0.05),而两组的雌激素受体阳性率、孕激素受体阳性率、人表皮生长因子受体2阳性率、M分期和TNM分期的差异无统计学意义(P>0.05)。年轻患者中Luminal B型所占比例高于年长患者。年轻与年长乳腺癌患者的中位生存期差异也无统计学意义(58.2 vs 45.8个月,P>0.05)。单因素分析结果表明,孕激素受体阴性、淋巴结阳性和远处转移与年轻乳腺癌患者5年生存率较低有关(P<0.05)。多因素分析结果表明,淋巴结阳性和远处转移是年轻乳腺癌患者5年生存率较低的独立预后因素。结论 :与年长患者相比,年轻乳腺癌患者的肿瘤T分期和N分期均较晚,Luminal B型所占比例较高,更倾向于接受保乳根治术,但总生存期无明显差异。

Objective: To explore and compare the clinical and pathologic features of breast cancer between the young women(< 40 years old) and the elder women(≥ 40 years old), and to evaluate the overall survival. Methods: There were 1 393 patients with breast cancer hospitalized in Department of Surgical Oncology, Sir Run Run Shaw Hospital, Medical College, Zhejiang University between August 1996 and April 2011. After exclusion of 15 patients whose information of age was missed, 1 378 patients(194 young and 1 184 elder patients) were included in this retrospective study. breast cancer patients who received treatment in Sir Run Run Shaw Hospital were retrospectively analyzed. The clinicopathological features and the survival were compared between the young and the elder patients. All patients were followed-up, and 218 were lost. The prognostic factors for all patients and young patients were analyzed, respectively. Results: The molecular subtypes, T stage, N stage and the rate of breast-conserving radical surgery were significantly different between the young and the elder patients(P < 0.05), but the positive rates of estrogen receptor(ER), progesterone receptor(PR) and human epidermal growth factor receptor-2(HER2) and the stages of M and TNM were not significantly different(P > 0.05). The proportion of Luminal B was higher in the young patients than that in the elder patients. The median survial time was not significantly different between the young and the elder patients(58.2 vs 45.8 months, P > 0.05). The univariate analysis revealed that PR-negative and lymph node and distant metastases were associated with lower five-year survival rate in young patients(P < 0.05). The multivariate analysis revealed that lymph node and distant metastases were independent prognostic factors in young patients(P < 0.05). Conclusion:Young patients with breast cancer have more poor prognostic factors than the elders, such as later stages of tumor size and lymph node, more proportion of type Luminal B, and higher rate of breast-conserving radical surgery, but the overall survival between the young and the elder patients had no significant difference.