乳腺癌术后远期复发转移患者临床特征分析
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摘要
目的乳腺癌复发转移主要集中在术后2～3年,术后5～6年是复发的另一个高峰。本研究探讨乳腺癌术后≥5年复发转移(远期复发)与<5年复发转移(短期复发)患者临床特征、治疗方式以及复发转移相关因素的差异,为筛选远期复发高危人群提供参考。方法收集1987-08-01-2016-12-31在山东大学附属山东省肿瘤医院确诊为乳腺癌复发转移的252例女性患者的完整临床资料,按照复发时间是否≥5年分为远期复发组和短期复发组,分析复发转移间隔与临床病理特征的相关性。结果 252例乳腺癌患者<5年复发转移170例(67.46%);≥5年复发转移82例(32.53%),其中≥7年复发转移52例(20.63%),≥10年复发转移18例(7.14%)。乳腺癌患者远期复发转移与患病年龄、是否绝经、PR和HER-2表达、是否新辅助化疗、是否术后内分泌治疗、临床分期、淋巴结转移数目、病理类型及手术方式有关,均P<0.05。结论分析乳腺癌术后≥5年复发相关临床病理特征,对于给不同患者制定规律随访周期有参考价值。
OBJECTIVE The recurrence and metastasis of breast cancer is mainly concentrated in 2-3 years after operation,and another peak of recurrence is 5-6 years after operation.Prognosis of breast cancer patients with long recurrence and metastasis is less concerned.This study was to investigate the differences between short-term(within 5 years)and long-term(above 5 years)recurrence and metastasis of postoperative breast cancer in terms of clinical features,treatments and related factors of recurrence and metastasis,providing reference for screening high-risk groups with long-term recurrence.METHODS Information of 252 recurrence and metastasis breast cancer patients diagnosed in Shandong Cancer Hospital from August 1 st,1987 to December 31 st,2016 were collected and divided in to short-term and long-term recurrence groups to analyze the relationship of the time of metastasis and recurrence and clinicopathological features.RESULTS There were 170 patients recurring and metastasizing within 5 years(67.46%)and 82 patients above 5 years(32.53%).Among the patients recurring and metastasizing above 5 years,there were 52 of them occurred above 7 years(20.63%)and 18 occurred above 10 years(7.14%).The long-term recurrence and metastasis was related to several factors,including younger ages,premenopause status,positive expression of PR,negative expression of HER-2,untreated with neoadjuvant chemotherapy and postoperative endocrine therapy,clinical stageⅠ-Ⅱ,number of lymph node metastasis≤3,unusual pathological types and modified radical mastectomy(P<0.05).CONCLUSION There are certain kind of clinicopathological features for the recurrence and metastasis of postoperative breast cancer patients,and this will provide valuable information to make follow-up plans.
OBJECTIVE The recurrence and metastasis of breast cancer is mainly concentrated in 2-3 years after operation,and another peak of recurrence is 5-6 years after operation.Prognosis of breast cancer patients with long recurrence and metastasis is less concerned.This study was to investigate the differences between short-term(within 5 years)and long-term(above 5 years)recurrence and metastasis of postoperative breast cancer in terms of clinical features,treatments and related factors of recurrence and metastasis,providing reference for screening high-risk groups with long-term recurrence.METHODS Information of 252 recurrence and metastasis breast cancer patients diagnosed in Shandong Cancer Hospital from August 1 st,1987 to December 31 st,2016 were collected and divided in to short-term and long-term recurrence groups to analyze the relationship of the time of metastasis and recurrence and clinicopathological features.RESULTS There were 170 patients recurring and metastasizing within 5 years(67.46%)and 82 patients above 5 years(32.53%).Among the patients recurring and metastasizing above 5 years,there were 52 of them occurred above 7 years(20.63%)and 18 occurred above 10 years(7.14%).The long-term recurrence and metastasis was related to several factors,including younger ages,premenopause status,positive expression of PR,negative expression of HER-2,untreated with neoadjuvant chemotherapy and postoperative endocrine therapy,clinical stageⅠ-Ⅱ,number of lymph node metastasis≤3,unusual pathological types and modified radical mastectomy(P<0.05).CONCLUSION There are certain kind of clinicopathological features for the recurrence and metastasis of postoperative breast cancer patients,and this will provide valuable information to make follow-up plans.
引文
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[9]周立民,王贻东,王长青.中晚期乳腺癌患者经新辅助化疗联合保乳手术治疗的临床效果观察[J].泰山医学院学报,2018,39(1):63-64.
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[11]Dent R,Trudeau M,Pritchard KI,et al.Triple-negative breast cancer:clinical features and patterns of recurrence[J].Clin Cancer Res,2007,13(15Pt 1):4429-4434.
[12]Cao L,Sun PL,Yao M,et al.Expression of YES-associated protein(YAP)and its clinical significance in breast cancer tissues[J].Hum Pathol,2017,68:166-174.
[13]穆凌光,孟少华,范秀廷,等.乳腺癌改良根治术患者术后复发转移的多因素分析[J].现代肿瘤医学,2018,26(17):2706-2710.
[14]Caswell-Jin JL,Plevritis SK,Tian L,et al.Change in survival in metastatic breast cancer with treatment advances:Meta-analysis and systematic review[J].JNCI Cancer Spectr,2018,2(4):pky062.
[15]刘琪,郭晓龙,左文述,等.乳腺癌术后复发转移间隔与临床病理因素相关性分析[J].中华肿瘤防治杂志,2014,21(7):522-527.
[2]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[3]Chang J,Clark GM,Allred DC,et al.Survival of patients with metastatic breast carcinoma:importance of prognostic markers of the primary tumor[J].Cancer,2003,97(3):545-53.
[4]Freedman GM,Anderson PR,Li T,et al.Locoregional recurrence of triple-negative breast cancer after breast-conserving surgery and radiation[J].Cancer,2009,115(5):946-951.
[5]石远凯,孙燕.临床肿瘤内科手册[M].6版.北京:人民卫生出版社,2015:349-350.
[6]曾愈程,康颖,刘芳,等.乳腺癌新辅助化疗疗效与预后关系研究进展[J].实用医学杂志,2018,34(10):1610-1612,1617.
[7]Kim J,Kim JH,Kim OB,et al.Clinical significance of the lymph node ratio in N1breast cancer[J].Radiat Oncol J,2017,35(3):227-232.
[8]朱辉琴,陈卫军,朱建华,等.改良根治术与保乳手术治疗早期乳腺癌患者的近远期疗效对照比较[J].中华普外科手术学杂志:电子版,2019,13(1):48-50.
[9]周立民,王贻东,王长青.中晚期乳腺癌患者经新辅助化疗联合保乳手术治疗的临床效果观察[J].泰山医学院学报,2018,39(1):63-64.
[10]McDonald ES,Clark AS,Tchou J,et al.Clinical diagnosis and management of breast cancer[J].J Nucl Med,2016,57(Suppl1):9-16.
[11]Dent R,Trudeau M,Pritchard KI,et al.Triple-negative breast cancer:clinical features and patterns of recurrence[J].Clin Cancer Res,2007,13(15Pt 1):4429-4434.
[12]Cao L,Sun PL,Yao M,et al.Expression of YES-associated protein(YAP)and its clinical significance in breast cancer tissues[J].Hum Pathol,2017,68:166-174.
[13]穆凌光,孟少华,范秀廷,等.乳腺癌改良根治术患者术后复发转移的多因素分析[J].现代肿瘤医学,2018,26(17):2706-2710.
[14]Caswell-Jin JL,Plevritis SK,Tian L,et al.Change in survival in metastatic breast cancer with treatment advances:Meta-analysis and systematic review[J].JNCI Cancer Spectr,2018,2(4):pky062.
[15]刘琪,郭晓龙,左文述,等.乳腺癌术后复发转移间隔与临床病理因素相关性分析[J].中华肿瘤防治杂志,2014,21(7):522-527.