luminal A型乳腺癌患者术后预后影响因素分析
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摘要
目的腋窝淋巴结转移增加了luminal A型乳腺癌患者复发转移的风险,因此本研究探讨腋窝淋巴结转移的luminal A型乳腺癌患者的临床病理特征、治疗方案及生存情况,并进行预后相关因素分析。方法选择2011-01-01-2012-12-31于西南医科大学附属医院经手术治疗病理确诊为luminal A型且腋窝淋巴结转移阳性的乳腺癌患者146例进行回顾性分析,随访5年,采用Log-rank检验和COX回归模型分析影响患者预后的临床病理特征及治疗方案。结果 146例腋窝淋巴结转移的luminal A型乳腺癌患者5年无病生存率为88.4%(129/146)。单因素分析结果显示,肿瘤大小(χ2=16.282,P=0.001)、淋巴结分级(χ2=8.962,P=0.011)、组织学分级(χ2=6.088,P=0.048)、全身治疗方式(χ2=4.121,P=0.042)和放疗情况(χ2=3.969,P=0.046)是影响患者复发转移的相关因素。COX回归模型分析结果显示,肿瘤大小(P=0.001)、淋巴结转移情况(P=0.008)是患者复发转移的独立危险因素,化疗+内分泌治疗(P=0.009)、行放疗(P=0.001)是患者复发转移的独立保护因素。结论肿瘤大小、淋巴结转移情况是影响患者预后的独立危险因素,术后行化疗+内分泌治疗,放疗是减少患者复发转移风险的独立保护因素,因此推荐伴腋窝淋巴结转移的lu-minal A型乳腺癌患者术后采用化疗+内分泌治疗+放疗的综合治疗方案。
OBJECTIVE Axillary lymph node metastasis increases the risk of recurrence and metastasis of patients with luminal A subtype breast cancer.The purpose of this research was to investigate clinicopathological features,treatment protocols and survival of patients with node-positive luminal A subtype breast cancer,and to explore the prognostic factors for node-positive luminal A subtype breast cancer.METHODS A retrospective analysis of 146 patients with breast cancer diagnosed with luminal A subtype breast cancer with axillary lymph node metastasis was performed at the Affiliated Hospital of Southwest Medical University from 2011.1.1 to 2012.12.31.The follow-up analysis was performed for5 years,using log-rank test and COX regression model to analyze clinicopathological features,treatment protocols that influence the prognosis of those patients.RESULTS The 5-year disease-free survival rate of patients with luminal A subtype breast cancer with axillary lymph node metastasis was 88.4%.Univariate analysis showed that tumor size(χ2=16.282,P=0.001),lymph node grading(χ2=8.962,P=0.011),histological grade(χ2=6.088,P=0.048),systemic treatment(χ2=4.121,P=0.042)and radiotherapy(χ2=3.969,P=0.046)were related factors affecting recurrence and metastasis of patients;COX regression analysis showed that tumor size(P=0.001)and lymph node metastasis(P=0.008)are independent risk factors for the prognosis of patients,chemotherapy+endocrine therapy(P=0.009)and radiotherapy(P = 0.001)are independent protective factors to reduce the risk of recurrence and metastasis.CONCLUSIONS Tumor size and lymph node metastasis are independent risk factors for the prognosis of patients,postoperative chemotherapy+endocrine therapy,radiotherapy are independent protective factors to reduce the risk of recurrence and metastasis.Therefore,this study recommends a comprehensive treatment regimen(chemotherapy+endocrine therapy+radiotherapy)for luminal type A breast cancer with axillary lymph node metastasis.
OBJECTIVE Axillary lymph node metastasis increases the risk of recurrence and metastasis of patients with luminal A subtype breast cancer.The purpose of this research was to investigate clinicopathological features,treatment protocols and survival of patients with node-positive luminal A subtype breast cancer,and to explore the prognostic factors for node-positive luminal A subtype breast cancer.METHODS A retrospective analysis of 146 patients with breast cancer diagnosed with luminal A subtype breast cancer with axillary lymph node metastasis was performed at the Affiliated Hospital of Southwest Medical University from 2011.1.1 to 2012.12.31.The follow-up analysis was performed for5 years,using log-rank test and COX regression model to analyze clinicopathological features,treatment protocols that influence the prognosis of those patients.RESULTS The 5-year disease-free survival rate of patients with luminal A subtype breast cancer with axillary lymph node metastasis was 88.4%.Univariate analysis showed that tumor size(χ2=16.282,P=0.001),lymph node grading(χ2=8.962,P=0.011),histological grade(χ2=6.088,P=0.048),systemic treatment(χ2=4.121,P=0.042)and radiotherapy(χ2=3.969,P=0.046)were related factors affecting recurrence and metastasis of patients;COX regression analysis showed that tumor size(P=0.001)and lymph node metastasis(P=0.008)are independent risk factors for the prognosis of patients,chemotherapy+endocrine therapy(P=0.009)and radiotherapy(P = 0.001)are independent protective factors to reduce the risk of recurrence and metastasis.CONCLUSIONS Tumor size and lymph node metastasis are independent risk factors for the prognosis of patients,postoperative chemotherapy+endocrine therapy,radiotherapy are independent protective factors to reduce the risk of recurrence and metastasis.Therefore,this study recommends a comprehensive treatment regimen(chemotherapy+endocrine therapy+radiotherapy)for luminal type A breast cancer with axillary lymph node metastasis.
引文
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[5]谢四梅,张安秦,朱彩霞,等.触诊及影像学检查对乳腺癌腋淋巴结转移状况预测价值探讨[J].中华肿瘤防治杂志,2014,21(15):1179-1183.
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[12]Liu N,Yang Z,Liu X.Lymph node status in different molecular subtype of breast cancer:triple negative tumours are more likely lymph node negative[J].Oncotarget,2017,8(33):55534-55543.
[13]Kwak HY,Chae BJ,Eom YH,et al.Is adjuvant chemotherapy omissible in women with T1-2stage,node-positive,luminal A type breast cancer?[J].J Chemother,2015,27(5):290-296.
[14]中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2017年版)[J].中国癌症杂志,2017,27(9):695-759.
[15]Park S,Lee SK,Paik HJ,et al.Adjuvant endocrine therapy alone in patients with node-positive,luminal A type breast cancer[J/CD].Medicine,2017,96(22):e6777.
[16]Han Y,Li Q,Xu BH,et al.Adjuvant chemotherapy may improve survival of patients with luminal A breast cancer and positive lymph nodes[J].Genet Mol Res,2015,14(3):8563-8573.
[17]田沛琦,孙亚冬,张崇建,等.Luminal A型乳腺癌腋窝淋巴结转移的高危因素分析[J].中国妇幼保健,2015,30(19):3239-3242.
[18]徐雨杰,王梦申,王翀,等.Luminal A型乳腺癌原发灶与淋巴结转移灶表型标志物差异性研究[J].中华肿瘤防治杂志,2018,25(9):642-646.
[19]Cihan YB.Role of postmastectomy radiation therapy in breast cancer patients with T1-2and 1-3positive lymph nodes[J].Onco Targets Ther,2016,9(9):5587-5595.
[20]Shen H,Zhao L,Wang L,et al.Postmastectomy radiotherapy benefit in Chinese breast cancer patients with T1-T2tumor and 1-3positive axillary lymph nodes by molecular subtypes:an analysis of 1369cases[J].Tumour Biol,2016,37(5):6465-6475.
[2]Hennigs A,Riedel F,Gondos A,et al.Prognosis of breast cancer molecular subtypes in routine clinical care:A large prospective cohort study[J].BMC Cancer,2016,16(1):734.
[3]李双,范红敏,肖菲菲,等.不同分子分型及临床病理特征与乳腺癌术后患者预后的关系[J].临床与实验病理学杂志,2016,32(1):39-44.
[4]马建萍,马芬兰.不同分子分型乳腺癌的临床病理特征及预后的关系[J].实用癌症杂志,2017,32(12):2041-2044,2048.
[5]谢四梅,张安秦,朱彩霞,等.触诊及影像学检查对乳腺癌腋淋巴结转移状况预测价值探讨[J].中华肿瘤防治杂志,2014,21(15):1179-1183.
[6]He ZY,Wu SG,Yang Q,et al.Breast cancer subtype is associated with axillary lymph node metastasis:A retrospective cohort study[J/CD].Medicine(Baltimore),2015,94(48):e2213.
[7]钟鸣,刘英霞,翁剑华,等.乳腺癌腋窝淋巴结转移的危险因素[J].热带医学杂志,2018,18(1):43-46,139.
[8]谢菲,王珏,朱倩男,等.乳腺癌分子分型与腋窝淋巴结转移的临床研究[J].中国肿瘤外科杂志,2018,10(3):147-149.
[9]宋聪睿,白玲,唐英,等.乳腺癌前哨淋巴结转移相关因素分析[J].中华肿瘤防治杂志,2016,23(18):1234-1238,1243.
[10]Rojas K.Breast cancer epidemiology and risk factors[J].Clin Obstet Gynecol,2016,59(4):651-672.
[11]张晓辉,孙强,周易冬,等.腋窝淋巴结转移乳腺癌患者的分子分型与临床病理特征和预后的关系[J].肿瘤,2013,33(3):271-275.
[12]Liu N,Yang Z,Liu X.Lymph node status in different molecular subtype of breast cancer:triple negative tumours are more likely lymph node negative[J].Oncotarget,2017,8(33):55534-55543.
[13]Kwak HY,Chae BJ,Eom YH,et al.Is adjuvant chemotherapy omissible in women with T1-2stage,node-positive,luminal A type breast cancer?[J].J Chemother,2015,27(5):290-296.
[14]中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2017年版)[J].中国癌症杂志,2017,27(9):695-759.
[15]Park S,Lee SK,Paik HJ,et al.Adjuvant endocrine therapy alone in patients with node-positive,luminal A type breast cancer[J/CD].Medicine,2017,96(22):e6777.
[16]Han Y,Li Q,Xu BH,et al.Adjuvant chemotherapy may improve survival of patients with luminal A breast cancer and positive lymph nodes[J].Genet Mol Res,2015,14(3):8563-8573.
[17]田沛琦,孙亚冬,张崇建,等.Luminal A型乳腺癌腋窝淋巴结转移的高危因素分析[J].中国妇幼保健,2015,30(19):3239-3242.
[18]徐雨杰,王梦申,王翀,等.Luminal A型乳腺癌原发灶与淋巴结转移灶表型标志物差异性研究[J].中华肿瘤防治杂志,2018,25(9):642-646.
[19]Cihan YB.Role of postmastectomy radiation therapy in breast cancer patients with T1-2and 1-3positive lymph nodes[J].Onco Targets Ther,2016,9(9):5587-5595.
[20]Shen H,Zhao L,Wang L,et al.Postmastectomy radiotherapy benefit in Chinese breast cancer patients with T1-T2tumor and 1-3positive axillary lymph nodes by molecular subtypes:an analysis of 1369cases[J].Tumour Biol,2016,37(5):6465-6475.