三阴性乳腺癌的预后及影响因素
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摘要
目的:探讨三阴性乳腺癌(triple-negative breast cancer,TNBC)患者的预后及其影响因素。方法:收集肿瘤外科2010年9月至2012年4月收治的TNBC患者92例为TNBC组,选取同期治疗的非TNBC患者100例为对照组,分析患者临床资料及随访情况。结果:随访结果表明,TNBC组患者复发或转移率为40.22%(37/92),高于非TNBC组的29.00%(29/100)(χ~2=9.664,P=0.022);TNBC组5年总生存率为68.48%(63/92),低于对照组的82.00%(82/100)(χ~2=7.546,P=0.006)。单因素分析结果显示,肿瘤大小、淋巴结状态、年龄、家族史、P53表达、Ki67表达与患者生存状态相关(P<0.05);logistic回归分析进一步表明,肿瘤体积大、淋巴结转移阳性、P53表达阳性和Ki67表达阳性率>14%是TNBC组患者死亡的独立危险因素。结论:与非TNBC患者相比,TNBC患者预后较差,其独立危险因素包括肿瘤体积较大、淋巴结阳性、P53阳性和Ki67高表达,对于非TNBC患者应采取更积极的治疗措施。
Objective: To investigate the prognosis and risk factors of triple-negative breast cancer( TNBC). Methods: The clinical data of 92 patients with TNBC admitted in the First Affiliated Hospital of Bengbu Medical College from September 2010 to April 2012 were collected. 100 non-TNBC patients undergoing treatment during the same period were enrolled as the control group. The clinical data and follow-up of patients were analyzed. Results: Follow-up results showed that the rate of recurrence and metastasis for TNBC was 40. 22 %( 37/92),higher than 29. 00% of non-TNBC( χ~2= 9. 664,P = 0. 022),and the difference was statistically significant( P < 0. 05). According to the overall survival rates of TNBC and non-TNBC,the overall survival rate of TNBC was obviously lower than that of non-TNBC( 68. 49 % and 82. 00 %,respectively,χ~2= 7. 546,P = 0. 006). Single factor analysis results showed that tumor size,lymph nodes status,age,family history,the positive expression of p53 and Ki67 were significantly related to the survival of TNBC. Logistic regression analysis further showed that larger tumor size,positive lymph nodes,the positive expression rate of p53 and Ki67( more than 14 %) were independent risk factors of death in TNBC. Conclusion: Compared with non-TNBC patients,TNBC patients have poor clinical prognosis. Larger tumor size,positive lymph nodes,high positive expression of p53 and Ki67 are important independent risk factors of TNBC. Non-TNBC patients should be given more aggressive treatment.
Objective: To investigate the prognosis and risk factors of triple-negative breast cancer( TNBC). Methods: The clinical data of 92 patients with TNBC admitted in the First Affiliated Hospital of Bengbu Medical College from September 2010 to April 2012 were collected. 100 non-TNBC patients undergoing treatment during the same period were enrolled as the control group. The clinical data and follow-up of patients were analyzed. Results: Follow-up results showed that the rate of recurrence and metastasis for TNBC was 40. 22 %( 37/92),higher than 29. 00% of non-TNBC( χ~2= 9. 664,P = 0. 022),and the difference was statistically significant( P < 0. 05). According to the overall survival rates of TNBC and non-TNBC,the overall survival rate of TNBC was obviously lower than that of non-TNBC( 68. 49 % and 82. 00 %,respectively,χ~2= 7. 546,P = 0. 006). Single factor analysis results showed that tumor size,lymph nodes status,age,family history,the positive expression of p53 and Ki67 were significantly related to the survival of TNBC. Logistic regression analysis further showed that larger tumor size,positive lymph nodes,the positive expression rate of p53 and Ki67( more than 14 %) were independent risk factors of death in TNBC. Conclusion: Compared with non-TNBC patients,TNBC patients have poor clinical prognosis. Larger tumor size,positive lymph nodes,high positive expression of p53 and Ki67 are important independent risk factors of TNBC. Non-TNBC patients should be given more aggressive treatment.
引文
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[10]雷珍,钟锡明,周岐,等.p53,Ki-6及E-钙黏蛋白在三阴性乳腺癌中的表达及预后[J].临床与病理杂志,2017,37(2):308-314.
[2]Schmidt G,Meyberg-Solomayer G,Gerlinger C,et al.Identification of prognostic different subgroups in triple negative breast cancer by Her2-neu protein expression[J].Arch Gynecol Obstet,2014,290(6):1221-1229.
[3]黄伟忠.乳腺癌不同分子分型和临床病理特征对预后的影响[J].包头医学院学报,2018,34(1):43-44.
[4]Dent R,Trudeau M,Pritchard KI,et al.Triple-negative breast cancer:clinical features and patterns of recurrence[J].Clin Cancer Res,2007,13(15):4429-4434.
[5]Munzone E,Botteri E,Sciandivasci A,et al.Prognostic value of Ki-67 labeling index in patients with node-negative,triple-negative breast cancer[J].Breast Cancer Res Treat,2012,134(1):277-282.
[6]Wang W,Wu J,Zhang P,et al.Prognostic and predictive value of Ki-67 in triple-negative breast cancer[J].Oncotarget,2016,7(21):31079-31087.
[7]Jin MS,Park IA,Kim JY,et al.New insight on the biological role of p53 protein as a tumor suppressor:re-evaluation of its clinical significance in triple-negative breast cancer[J].Tumour Biol,2016,37(8):11017-11024.
[8]Payandeh M,Sadeghi M,Sadeghi E,et al.Expression of p53Breast Cancer in Kurdish Women in the West of Iran:a Reverse Correlation with Lymph Node Metastasis[J].Asian Pac J Cancer Prev,2016,17(3):1261-1264.
[9]项鹏程,白雪峰.ER,PR,Her-2,P53在乳腺癌中的表达及其相关意义[J].包头医学院学报,2015,31(9):3-4,80.
[10]雷珍,钟锡明,周岐,等.p53,Ki-6及E-钙黏蛋白在三阴性乳腺癌中的表达及预后[J].临床与病理杂志,2017,37(2):308-314.