内分泌治疗雌激素受体低表达乳腺癌患者的预后分析

Prognostic analysis of endocrine therapy for breast cancer with low estrogen receptor expression

    摘要
  • 摘要:
    目的 探讨内分泌治疗对雌激素受体（estrogen receptor，ER）低表达乳腺癌预后的影响并筛选独立预后因素。
    方法 回顾性分析2014年1月至2020年5月就诊于新疆医科大学附属肿瘤医院手术后经病理确诊为ER低表达且TNM分期为Ⅰ～Ⅲ期的387例女性乳腺癌患者的临床病理资料，根据是否内分泌治疗（endocrine therapy，ET）分为ET组和无ET组，使用倾向性评分匹配（propensity score matching，PSM）平衡组间差异，采用生存分析及Cox比例风险模型分析预后及独立影响因素。
    结果 387例患者中，ET组为214例（55.3%），无ET组为173例（44.7%），基线资料显示无ET在少数民族、较多区域淋巴结转移、较晚的TNM分期、未接受放疗的患者中更为常见。PSM后ET组（n=132）和无ET组（n=132）的基线资料差异无统计学意义。生存分析显示PSM前ET组与无ET组的5年总生存（overall survival，OS）率分别为93.4%、72.8%，5年无病生存（disease-free survival，DFS）率分别为74.1%、60.9%（均P<0.05）。PSM后，ET组与无ET组的5年OS率分别为91.6%、80.1%（P<0.05），5年DFS率分别为71.1%、68.1%（P>0.05）。多因素分析显示是否接受ET、CK5/6表达状态、肿瘤大小T3、淋巴结N2和N3、是否放疗是OS的独立影响因素（均P<0.05）。CK5/6表达状态、肿瘤大小T3、淋巴结转移N2和N3、是否接受放疗、是否靶向治疗是DFS的独立影响因素（均P<0.05）。
    结论 内分泌治疗可显著改善ER低表达乳腺癌患者的5年OS。CK5/6阳性、大体积肿瘤（T3）、区域淋巴结转移N2、N3是5年OS和DFS共同的独立危险因素，辅助放疗和曲妥珠单抗治疗可显著改善预后。

     

    Abstract:
    Objective  To investigate the impact of endocrine therapy (ET) on the prognosis of breast cancer patients with low estrogen receptor (ER) expression and to identify the associated independent prognostic factors.
    Methods  We retrospectively analyzed the clinicopathological data of 387 female patients with breast cancer with low ER expression and at stage Ⅰ-Ⅲ TNM who were treated surgically at Xinjiang Medical University Affiliated Tumor Hospital between January 2014 and May 2020. The patients were stratified into ET and non-ET groups based on whether they received ET administration. Propensity score matching (PSM) was used to balance intergroup differences, and survival analysis along with Cox proportional hazards models were applied to assess prognosis and the associated independent influencing factors.
    Results Among the 387 patients, 214 (55.3%) received ET and 173 (44.7%) did not. Baseline data indicated that the non-ET group exhibited higher proportions of ethnic minorities and patients with regional lymph node involvement, advanced TNM stage, and no radiotherapy administration. After PSM, baseline characteristics showed no significant differences between the ET (n=132) and non-ET groups (n=132). Pre-PSM survival analysis revealed 5-year overall survival (OS) rates of 93.4% and 72.8% and 5-year disease-free survival (DFS) rates of 74.1% and 60.9% for the ET and non-ET groups, respectively; both rates showed statistically significant differences between the groups (P<0.05). Post-PSM, the 5-year OS rates significantly differed between the ET and non-ET groups (91.6% and 80.1%, respectively; P<0.05), whereas no significant difference in 5-year DFS rates were observed (71.1% ET group vs. 68.1% non-ET group, P>0.05). Multivariate analysis identified the following independent prognostic factors: for OS, ET administration, CK5/6 status, tumor size T3, lymph node status N2/N3, and radiotherapy administration (all P<0.05). For DFS, the independent factors included CK5/6 status, tumor size T3, lymph node status N2/N3, radiotherapy administration, and targeted therapy (all P<0.05).
    Conclusions Endocrine therapy significantly improved the 5-year OS in breast cancer patients with low ER expression. CK5/6 positivity, large tumor size (T3), and regional lymph node involvement (N2/N3) were independent risk factors for both 5-year OS and DFS. Adjuvant radiotherapy and trastuzumab-based therapy significantly improved prognosis.

     

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