影响乳腺癌术后化疗联合放疗患者远期预后的相关因素分析
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摘要
目的研究影响乳腺癌术后化疗联合放疗患者远期预后的相关因素。方法选取成都医学院第一附属医院2012年1月至2015年1月行乳腺癌根治术患者,共174例,术后均接受化疗联合放疗。收集年龄、月经状态、肿瘤直径、淋巴结状态、肿瘤部位、病理类型、癌症家族史、雌激素受体、孕激素受体、原癌基因人类表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)表达等临床及病理资料。所有患者均接受为期3年随访,以患者肿瘤复发或死亡为终点。无病生存期≤3年患者纳入预后不良组,无病生存期>3年患者纳入预后良好组,比较2组临床及病理资料。结果 174例患者有效随访人数166例,其中复发24例,死亡6例,预后不良率为18.1%。预后良好组年龄>40岁、肿瘤直径<2 cm、无淋巴结转移、非浸润性癌、雌激素受体阳性、孕激素受体阳性、HER2阴性患者比例显著高于预后不良组(P<0.05)。结论年龄、肿瘤直径、淋巴结状态、病理类型、雌激素受体、孕激素受体、HER2表达情况等7个因素对乳腺癌患者预后有显著影响。
Objective To study the related factors influencing the long-term prognosis of chemotherapy combined with radiotherapy after surgery for breast cancer. Methods One hundred and seventy-four patients who underwent radical mastectomy in the hospital from January 2012 to January 2015 were selected. All of them were treated by chemotherapy combined with radiotherapy after surgery. The clinicopathological data of patients such as age,menstrual status,tumor diameter,lymph node status,tumor location,pathological type,family history of cancer,estrogen receptor,progesterone receptor and expression of proto-oncogene human epidermal growth factor receptor 2( HER2) were collected. All patients were followed up for 3 years. The patients were grouped with tumor recurrence or death as the endpoint. Patients with disease-free survival( DFS) ≤3 years were included in the poor prognosis group,and patients with DFS > 3 years were included in the good prognosis group. The clinicopathological data were compared between the two groups. Results In174 patients,166 cases were followed up effectively,including 24 cases with recurrence and 6 death cases. The rate of poor prognosis was 18. 1%. The proportions of patients older than 40 years old,with tumor diameter shorter than 2 cm,without lymph node metastasis,with non-invasive cancer,estrogen receptor positive,progesterone receptor positive and HER2 negative patients in the good prognosis group were significantly higher than those in the poor prognosis group( P<0. 05). Conclusion Age,tumor diameter,lymph node status,pathological type,estrogen receptor,progesterone receptor and expression of HER2 have significantin fluence on the prognosis of patients with breast cancer.
Objective To study the related factors influencing the long-term prognosis of chemotherapy combined with radiotherapy after surgery for breast cancer. Methods One hundred and seventy-four patients who underwent radical mastectomy in the hospital from January 2012 to January 2015 were selected. All of them were treated by chemotherapy combined with radiotherapy after surgery. The clinicopathological data of patients such as age,menstrual status,tumor diameter,lymph node status,tumor location,pathological type,family history of cancer,estrogen receptor,progesterone receptor and expression of proto-oncogene human epidermal growth factor receptor 2( HER2) were collected. All patients were followed up for 3 years. The patients were grouped with tumor recurrence or death as the endpoint. Patients with disease-free survival( DFS) ≤3 years were included in the poor prognosis group,and patients with DFS > 3 years were included in the good prognosis group. The clinicopathological data were compared between the two groups. Results In174 patients,166 cases were followed up effectively,including 24 cases with recurrence and 6 death cases. The rate of poor prognosis was 18. 1%. The proportions of patients older than 40 years old,with tumor diameter shorter than 2 cm,without lymph node metastasis,with non-invasive cancer,estrogen receptor positive,progesterone receptor positive and HER2 negative patients in the good prognosis group were significantly higher than those in the poor prognosis group( P<0. 05). Conclusion Age,tumor diameter,lymph node status,pathological type,estrogen receptor,progesterone receptor and expression of HER2 have significantin fluence on the prognosis of patients with breast cancer.
引文
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[16]Xu F,He H,Huang W,et al.Decreased expression of MicroRNA-200 family in human breast cancer is associated with lymph node metastasis[J].Clin Transl Oncol,2016,18(3):283-288.
[17]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.
[18]汪洁,唐锋,包芸,等.临床和病理因素对双侧乳腺癌预后的影响[J].中国临床药理学杂志,2016,32(4):321-323.
[19]Fribbens C,O’Leary B,Kilburn L,et al.Plasma ESR1 mutations and the treatment of estrogen receptor-positive advanced breast cancer[J].J Clin Oncol,2016,34(25):2961-2968.
[20]DeM archi T,Foekens JA,Umar A,et al.Endocrine therapy resistance in estrogen receptor(ER)-positive breast cancer[J].Drug Discov Today,2016,21(7):1181-1188.
[2]宫舒萍,房巧玲,刘守钦,等.济南市城乡女性乳腺癌2012-2015年发病和死亡分析[J].中华肿瘤防治杂志,2016,23(21):1403-1406.
[3]Colleoni M,Orvieto E,NoléF,et al.Prediction of response to primary chemotherapy for operable breast cancer[J].Eur J Cancer,1999,35(4):574-579.
[4]夏重升,李苗苗,范敏,等.早期乳腺癌保乳术后瘤床同步加量调强放疗的临床观察[J].中华放射医学与防护杂志,2017,37(2):119-124.
[5]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(2011版)[J].中国癌症杂志,2011,21(5):367-417.
[6]Peele PB,Siminoff LA,Xu Y,et al.Decreased use of adjuvant breast cancer therapy in a randomized controlled trial of a decision aid with individualized risk information[J].Med Decis Making,2005,25(3):301-307.(下转第166页)
[7]黄焰,曾敏.乳腺癌新辅助化疗再认识[J].中国肿瘤临床,2016,43(15):643-645.
[8]王清华,李志勇,姚旭,等.某医院乳腺癌术后化疗的生存分析[J].中国卫生统计,2017,34(3):497-498.
[9]钟秋子,王智,唐玉,等.乳腺癌保乳术后放化疗顺序对患者预后的影响[J].中华肿瘤杂志,2017,39(4):308-314.
[10]Maillart LM,Ivy JS,Ransom S,et al.Assessing dynamic breast cancer screening policies[J].Oper Res,2008,56(6):1411-1427.
[11]Ohta K,Kasahara Y,Tanaka F,et al.Is clinical breast examination effective in Japan?Consideration from the agespecific performance of breast cancer screening combining mammography with clinical breast examination[J].Breast Cancer,2016,23(2):183-189.
[12]吴晖,史静琤,欧阳取长,等.130例乳腺癌术后胸壁复发患者预后相关因素分析[J].中国现代医学杂志,2016,26(21):131-135.
[13]韦常宏,陈伊,宁淑芳,等.绝经后及年轻女性乳腺癌患者肿瘤分子分型及临床病理特征对比观察[J].山东医药,2016,56(43):93-95.
[14]Cook ED,Iglehart EI,Baum G,et al.Missing documentation in breast cancer survivors:genitourinary syndrome of menopause[J].Menopause,2017,24(12):1360-1364.
[15]沈晓东,潘高峰,刘维燕,等.乳腺癌临床病理特征对预后判断的价值[J].蚌埠医学院学报,2016,41(12):1642-1646.
[16]Xu F,He H,Huang W,et al.Decreased expression of MicroRNA-200 family in human breast cancer is associated with lymph node metastasis[J].Clin Transl Oncol,2016,18(3):283-288.
[17]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.
[18]汪洁,唐锋,包芸,等.临床和病理因素对双侧乳腺癌预后的影响[J].中国临床药理学杂志,2016,32(4):321-323.
[19]Fribbens C,O’Leary B,Kilburn L,et al.Plasma ESR1 mutations and the treatment of estrogen receptor-positive advanced breast cancer[J].J Clin Oncol,2016,34(25):2961-2968.
[20]DeM archi T,Foekens JA,Umar A,et al.Endocrine therapy resistance in estrogen receptor(ER)-positive breast cancer[J].Drug Discov Today,2016,21(7):1181-1188.