早期乳腺癌患者预后因素分析

陈忠杰; 庄洪卿; 郝建磊; 王平

doi:10.3969/j.issn.1000-8179.2011.09.011

摘要: 目的：研究T1～T2、 0～3枚阳性淋巴结乳腺癌患者肿瘤复发和生存的预后因素。方法：回顾分析天津医科大学附属肿瘤医院收治的540例乳腺癌患者资料。进行单因素变量分析及Cox回归分析肿瘤复发和生存的预后因素。结果： >20%阳性腋窝淋巴结率是影响肿瘤局部复发的预后因素（HR=12.816， P<0.001）； >20%阳性淋巴结率和浸润性导管癌是影响肿瘤远处转移的预后因素（HR=11.088， P<0.001； HR=0.390， P=0.018）； 1～3枚阳性淋巴结和>20%阳性淋巴结数是显著影响10年总生存率的预后因素（HR=2.110， P=0.001； HR=10.244， P<0.001），二者也是影响10年无瘤生存率的预后因素（HR=1.634， P=0.004； HR=7.339， P<0.001）。结论：腋窝淋巴结有无转移是影响10年局部复发，远处转移，总生存率和无瘤生存率的重要的预后因素。原发肿瘤组织病理是显著影响10年肿瘤远处转移的预后因素。

Abstract: Analysis of Prognostic Factors for Patients with Early Breast CancerZhongjie CHEN, Hongqing ZHUANG, Jianlei HAO, PingWANGCorrespondence to: PingWANG, E-mail: docczj@sina.comDepartment of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, ChinaAbstract Objective: To identify prognostic factors for patients with T1 to T2 breast cancer and 0 to 3 positive axillary lymphnodes. Methods: Data from 540 breast cancer patients with T1-T2 tumors and 0 to 3 positive nodes were reviewed. The 10-year loco-re-gional recurrence ( LRR ), distant recurrence ( DR ), disease-free survival ( DFS ) and overall survival ( OS ) of the patients were ana-lyzed. Univariate statistical analysis and Cox proportional hazards models were carried out using SPSS software v.16.0. Results: Themedian follow-up was 7.2 years. In multivariate analysis, the positive rate of over 20% of axillary node was the only variable that ad-versely influenced LRR ( hazard ratio HR , 12.816; 95% confidence interval, 4.657-35.266, P < 0.00 1 ). The positive rate of over20% of axillary node and ductal carcinoma were the variables that adversely influenced DR ( HR, 11.088, 95% confidence interval,3.807-32.297, P < 0.001; HR, 0.390, 95% confidence interval, 0.179-0.851, P = 0.018 ). One to 3 positive axillary nodes and the rate ofover 20% of positive axillary nodes were the only variables that had negative effect on the 10-year OS rate (HR, 2.110, 95% confidenceinterval, 1.364-3.264, P = 0.001; HR, 10.244, 95% confidence interval, 3.497-30.011, P < 0.001 ) and they were also adverse prognosticfactors for the 10-year DFS ( HR, 1.634, 95% confidence interval, 1.171-2.279, P = 0.004; HR, 7.339, 95% confidence interval,2.906-18.530, P < 0.001 ). Conclusion: The status of axillary lymph node is the only prognostic factor having a significant impact onthe 10-year LRR, DR, OS and DFS. Patients with T1-T2 breast cancer and 1 to 3 positive lymph nodes showed higher 10-year LRR andDR, and lower 10-year OS and DFS, compared with patients with negative lymph nodes. The histopathologic results of primary tumorsare the significant prognostic factors for 10-year DR.Keywords Breast neoplasms; Prognosis; Lymph nodes