乳腺癌化疗敏感性及预后因素研究
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摘要
背景及目的：乳腺癌患者的耐药问题一直是多年来难以克服与解决的问题。本研究基于抗微管类药物(埃博霉素B和紫杉类)为主的化疗方案,分别从耐药蛋白及miRNA两个方面入手,进行耐药相关因素的分析。一、目前认为,埃博霉素B的耐药与MRP7蛋白可能相关,所以我们选择单纯应用埃博霉素B的患者,进行体内MRP7的检测,以期发现MRP7与埃博霉素B药代及药效的相关性。二、含紫杉类化疗方案是多数乳腺癌需要采用的方案,而luminal A型乳腺癌中只有部分患者会对该化疗方案敏感,另一部分患者对该方案并不敏感。本研究希望能够通过血清miRNA检测,筛查出对含紫杉类化疗方案耐药的标记miRNAs,从而更好地指导luminal A型乳腺癌的临床化疗。
方法：一、结合我科进行的埃博霉素B的Ⅰ期临床试验,采集患者不同时间点的血样,进行药代动力学检测。采用免疫组化及流式细胞仪检测MRP7蛋白在组织及外周血的表达,研究MRP7的表达与埃博霉素B药代动力学及疗效的关系。采用Winnonlin药代动力学统计软件拟合血药浓度-时间数据,求得注射用埃博霉素B在人体内的上述药代动力学参数,其中AUC采用梯形面积法估算。运用置信区间法评价药动学参数与给药剂量的相关性。回归分析得到标准曲线回归方程。组间比较采用双变量spearman相关分析法。所有检验取双侧检验,检验水准为α=0.05,P<0.05表示有统计学意义。二、留取我院接受葸环联合紫杉(AT)方案新辅助化疗的luminal A型乳腺癌患者的血清标本,根据疗效分为治疗敏感组与耐药组,提取血清中总RNA。选取敏感组和耐药组准确配对的患者血清各6份,预扩后,采用TaqMan Real-time PCR芯片pool法检测差异表达的1microRNA。挑选出临床病理因素匹配均衡的敏感组38例,耐药组30例,针对芯片筛选出来差异明显的miRNAs,利用荧光定量PCR方法进行扩大样本量的验证。对验证结果证实差异表达的miRNAs进行分析,探讨其对于新辅助化疗疗效的预测价值。采用RQ manager1.2和Data AsistV2.0软件对microRNA芯片结果进行分析。SPSS16.0软件进行数据统计分析。临床病理特征变量采用统计描述,计量资料的比较采用t检验(Student's t test);连续变量两组间差异比较采用非参数检验中Mann-Whitney U检验。P值为双侧性,小于0.05认为有统计学意义。
结果：1、药代动力学方面：流式细胞仪检测外周血中的MRP7的平均荧光强度与药代动力学参数AUCC(P=0.001)、t1/2β(P=0.039)、Cmax(P=0.017)以及Cl(P=0.001)之间明显相关。其中,MRP7与AUC、t1/2β、Cmax呈负相关,与Cl呈正相关。流式细胞荧光阳性染色细胞数与Cl呈现正相关(P=0.026),而组织中MRP7表达并未显示出与药代动力学参数的明显相关性。疗效方面：17例患者的MRP7在组织中的表达程度均较高,仅有1例显示出局部缓解(PR)的患者,其MRP7的组织表达相对较低,外周血的MRP7平均荧光强度相对较弱,显示出MRP7在外周血及组织的表达与疗效可能存在相关性。同时,这一例有效患者的AUC、t1/2β在同一剂量组的三例患者中最高,Cl在全组17例患者中最低,预示着AUC、t1/2β及Cl等药代动力学参数可能与疗效具有相关性。2、基于芯片表达谱差异,从217个差异表达的microRNAs中,我们挑选出9个组间表达差异更为明显的miRNAs,在68例lumina1A型乳腺癌患者(耐药组30例,敏感组38例)中进行验证。结果显示let-7b、miR-205、 miR-19a和miR-27a在化疗耐药组和敏感组之间表达差异明显,具有统计学意义(P<0.05)。其中,miR-19a与miR-27a在耐药组的表达为化疗敏感组的1.56倍,差异更为显著。
结论：1、乳腺癌患者体内的MRP7表达对埃博霉素的药代动力学有影响,也有影响疗效的趋势。同时,药代动力学与疗效之间也可能存在相关性。2、luminal A型乳腺癌患者血清中的(?)miR-27a-3p、miR-19a-3p、miR-205-5p及let-7b-5p表达与紫杉联合蒽环类化疗方案的敏感性相关。
目的：研究乳腺癌合并腹股沟淋巴结转移患者的临床表现、病理学特点和影响预后的因素。
方法：收集1999年1月至2010年12月收治的17例乳腺癌合并腹股沟淋巴结转移患者的临床资料,分析其临床病理特征和预后影响因素。
结果：17例伴有腹股沟淋巴结转移的乳腺癌患者占同期乳腺癌患者收治总数的0.11%,其中合并其他部位转移15例(88.2%),单纯腹股沟淋巴结转移2例(11.8%)。17例患者均接受了雌激素受体(ER)和(或)孕激素受体(PR)检测,10例(58.8%)阳性,7例(41.2%)阴性。13例患者接受了表皮生长因子受体2(HER-2)检测,其中4例(30.8%)阳性。16例患者接受手术治疗,术中发现9例患者的腋窝淋巴结转移≥4枚。17例患者均接受化疗。中位随访时间为156个月,全组患者的5年生存率为49.9%。单因素分析结果显示,腋窝转移淋巴结≥4枚、ER和(或)PR阴性、辅助化疗周期数≤6个、确诊时分期为Ⅲ、Ⅳ期以及发现乳腺癌至腹股沟淋巴结转移的时间≤36个月为患者无进展生存时间(PFS)的不良预后因素(均P<0.05)。腋窝转移淋巴结≥4枚、ER和(或)PR阴性、辅助化疗周期数≤6个、首次复发为多发远处转移、发现乳腺癌至腹股沟淋巴结转移的时间≤36个月以及合并胸腔积液为患者总生存的不良预后因素(均P<0.05)。多因素分析结果显示,发现乳腺癌至腹股沟淋巴结转移的时间是影响患者无进展生存时间(PFS)的独立预后因素(P<0.05)。
结论：影响乳腺癌合并腹股沟淋巴结转移患者预后的主要因素为腋窝淋巴结转移数目、激素受体状态、辅助化疗周期数、首次复发转移类型、发现乳腺癌至腹股沟淋巴结转移的时间以及是否有胸腔积液。术后定时全面复查、对高危人群及时给予强化治疗对改善患者的预后可能有一定的积极意义,但也需要探索更为合理的个体化综合治疗方案。
Background and purpose:It is difficult to overcome the problem of drug-resistance in breast cancer patients. This study is based on the anti-microtubules drugs(including epothilone B and taxanes), for the aim to analysize the resistant factors including resistant protein and miRNA. First, it was reported that MRP7may contribute to the resistance of epothilone B,so the patients with epothilone B only in one of our phase I clinical trials were enrolled in our study.We detect the expression of MRP7in vivo and hope to find the relationship between epothilone B and MRP7. Second, taxanes based chemotherapy was one of the most common choices in breast cancer treatment. The type of luminal A was only partly sensitive to chemotherapy, including taxanes based chemotherapy. The aim of our study is to find the biomarkers of chemotherapy resistance by detecting miRNAs in serum, which may give direction to clinical treatment choice in the type of luminal A breast cancer patients.
Methods:First, based on the epothilone B phase I clinical trial in our department, we collected blood samples from patients at different time points, to detect the pharmaco kinetic parameters. We want to find the relationship between MRP7expression and epothilone B pharmacokinetics as well as efficacy by detecting MRP7protein expression in cancer tissue and peripheral blood with immunohistochemistry and flow cytometry respectively. Winnonlin pharmacokinetic statistics software was used to make blood drug concentration-time curve fit. To get pharmacokinetic parameters of epothilone B in vivo, the trapezoidal area method was used to estimate AUC. Confidence interval method was used to evaluate the relationship between pharmacokinetic parameters and drug doses. Standard curve regression equation was obtained by regression analysis. Double variable spearman correlation analysis was used between two groups. All inspection was bilateral, with standards of alpha=0.05, P<0.05indicates statistical significance. Secondly, obtain the serum sample of luminal A type breast cancer patients who received anthracycline combined with taxanes (AT) regimen before surgery. Based on the sensitivity differences to AT regimen, sensitive and resistant groups were separated, total RNA in serum was extracted. As a pool,6samples of accurate matching patients were selected in sensitive and resistant groups respectively. After pre-amplification, TaqMan Real-time PCR chip was used to detect differentially expressed miRNAs. Selected38cases from sensitive group, and30cases from drug-resistant group with well-balanced clinical pathologic features. Fluorescence quantitative polymerase chain reaction (PCR) was used to verify the miRNAs with apparent differences from chip screening in a larger sample size. Analyze the results after confirmation and explore the predictive value of these miRNAs in chemosensitivity. RQ manager1.2and Data Asist V2.0software was used to analyze the chip. SPSS16.0software was used for statistical analysis. Statistical description was used to describe the clinical pathological features, t test (Student's t test) was used to analyze measurement data; Mann-Whitney U in nonparametric test was used to analyze the continuous variable. P value was bilateral tested less than0.05was regarded as statistical significance.
Results:First, pharmacokinetic:we found the average fluorescence intensity from peripheral blood MRP7and the pharmacokinetic parameters including AUC (P=0.001), t1/2β (P=0.039), the Cmax (P=0.017) and Cl (P=0.001) were significantly correlated. Negative correlation was found in the MRP7fluorescence intensity and AUC, t1/2β, Cmax, and positive correlation was found both in MRP7fluorescence intensity and positive staining cells with Cl (P=0.026). However, MRP7in tissue does not show obvious correlation with pharmacokinetic parameters. Efficacy:MRP7expression levels in tissue were high in all of the17patients. But for the only one who got partial response (PR), her MRP7expression in tissue was relatively low, and MRP7average fluorescence intensity was relatively weak in peripheral blood. These data showed that MRP7expression may have relationship with efficacy. At the same time, the AUC, tl/2β in the only patient who got response were the highest in the three patients with same dose level, and her Cl was the lowest in all of the17patients. These data indicated that the pharmacokinetic parameters of AUC, tl/2(3and Cl might have correlation with efficacy. Second, based on217differentially expressed microRNAs screened by miRNA chip, we selected9miRNAs which show more apparent differences between the two groups, and gave validation in68cases of type luminal A breast cancer (30cases from resistant group,38cases from sensitive group). Results show that the let-7b, miR-205, miR-19a and miR-27a were obviously different between the two groups. The difference was statistically significant (P<0.05). Among them, miR-19a and miR-27a showed more significant difference with1.56fold between the two groups than the other two miRNAs.
Conclusion:First, MRP7expression may influence drug pharmacokinetic parameters in breast cancer patients, and may have a tendency to affect efficacy. At the same time, there may be correlation between pharmacokinetic and efficacy. Second, miR-27a-3p%miR-19a-3p/、miR-205-5p and let-7b-5p miRNAs in serum of breast cancer patients with luminal A type are associated with chemosensitivity.
Objective To analyze the clinicopathological feature and prognostic factors of breast cancer patients with inguinal lymph node metastasis.
Methods From January1999to December2010,17breast cancer patients with inguinal lymph node metastasis were treated in our cancer center. All of the patients had a history of breast cancer without the other primary cancer. Clinicopathological characteristics, prognostic factors were surveyed.
Results The frequency of breast cancer cases who occurred inguinal lymph node metastasis was0.11%in the period.2patients (11.8%) had inguinal lymph node metastasis only, multi-sites metastases were observed in the remaining15(88.2%) patients. The number of ER and/or PR-positive and negative were10(58.8%) and7(41.2%) respectively, and in the13cases who underwent HER-2test, the number of HER-2-positive was4(30.8%). For the16patients who underwent surgery,9patients were detected metastatic axillary lymph nodes equal or greater than4. All of the17patients were treated with chemotherapy. The median follow-up time was156months. The5year overall survival was49.9%. Univariate analysis revealed that metastatic axillary lymph nodes>4, ER and (or)PR negative, adjuvant chemotherapy<6cycles, disease stage as III/IV at diagnosis and the period from diagnosis of breast cancer to the occurrence of inguinal lymph node metastasis<36months were predictors of shorter PFS (P<0.050). Metastatic axillary lymph nodes>4, ER and (or)PR negative, adjuvant chemotherapy≤6cycles, primary recurrence as multiple distant metastases, the period from diagnosis of breast cancer to the occurrence of inguinal lymph nodes metastasis≤<36months and pleural effusion were predictors of shorter OS (P<0.05).Multivariate analysis revealed that the period from diagnosis of breast cancer to the occurrence of inguinal lymph node metastasis was the only independent prognostic factor concerning PFS(P<0.05).
Conclusions The prognostic factors of breast cancer patients with inguinal lymph node metastasis included the number of metastatic axillary lymph nodes, ER and (or) PR status, the cycles of adjuvant chemotherapy, type of primary recurrence, the period from diagnosis of breast cancer to the occurrence of inguinal lymph node metastasis and pleural effusion. Regular and complete physical examination after surgery as well as prompt intensive treatment for high-risk patients may have positive significance in the treatment of such type of patients, still, a type of more reasonable and individualized treatment must be in need in future.
方法：一、结合我科进行的埃博霉素B的Ⅰ期临床试验,采集患者不同时间点的血样,进行药代动力学检测。采用免疫组化及流式细胞仪检测MRP7蛋白在组织及外周血的表达,研究MRP7的表达与埃博霉素B药代动力学及疗效的关系。采用Winnonlin药代动力学统计软件拟合血药浓度-时间数据,求得注射用埃博霉素B在人体内的上述药代动力学参数,其中AUC采用梯形面积法估算。运用置信区间法评价药动学参数与给药剂量的相关性。回归分析得到标准曲线回归方程。组间比较采用双变量spearman相关分析法。所有检验取双侧检验,检验水准为α=0.05,P<0.05表示有统计学意义。二、留取我院接受葸环联合紫杉(AT)方案新辅助化疗的luminal A型乳腺癌患者的血清标本,根据疗效分为治疗敏感组与耐药组,提取血清中总RNA。选取敏感组和耐药组准确配对的患者血清各6份,预扩后,采用TaqMan Real-time PCR芯片pool法检测差异表达的1microRNA。挑选出临床病理因素匹配均衡的敏感组38例,耐药组30例,针对芯片筛选出来差异明显的miRNAs,利用荧光定量PCR方法进行扩大样本量的验证。对验证结果证实差异表达的miRNAs进行分析,探讨其对于新辅助化疗疗效的预测价值。采用RQ manager1.2和Data AsistV2.0软件对microRNA芯片结果进行分析。SPSS16.0软件进行数据统计分析。临床病理特征变量采用统计描述,计量资料的比较采用t检验(Student's t test);连续变量两组间差异比较采用非参数检验中Mann-Whitney U检验。P值为双侧性,小于0.05认为有统计学意义。
结果：1、药代动力学方面：流式细胞仪检测外周血中的MRP7的平均荧光强度与药代动力学参数AUCC(P=0.001)、t1/2β(P=0.039)、Cmax(P=0.017)以及Cl(P=0.001)之间明显相关。其中,MRP7与AUC、t1/2β、Cmax呈负相关,与Cl呈正相关。流式细胞荧光阳性染色细胞数与Cl呈现正相关(P=0.026),而组织中MRP7表达并未显示出与药代动力学参数的明显相关性。疗效方面：17例患者的MRP7在组织中的表达程度均较高,仅有1例显示出局部缓解(PR)的患者,其MRP7的组织表达相对较低,外周血的MRP7平均荧光强度相对较弱,显示出MRP7在外周血及组织的表达与疗效可能存在相关性。同时,这一例有效患者的AUC、t1/2β在同一剂量组的三例患者中最高,Cl在全组17例患者中最低,预示着AUC、t1/2β及Cl等药代动力学参数可能与疗效具有相关性。2、基于芯片表达谱差异,从217个差异表达的microRNAs中,我们挑选出9个组间表达差异更为明显的miRNAs,在68例lumina1A型乳腺癌患者(耐药组30例,敏感组38例)中进行验证。结果显示let-7b、miR-205、 miR-19a和miR-27a在化疗耐药组和敏感组之间表达差异明显,具有统计学意义(P<0.05)。其中,miR-19a与miR-27a在耐药组的表达为化疗敏感组的1.56倍,差异更为显著。
结论：1、乳腺癌患者体内的MRP7表达对埃博霉素的药代动力学有影响,也有影响疗效的趋势。同时,药代动力学与疗效之间也可能存在相关性。2、luminal A型乳腺癌患者血清中的(?)miR-27a-3p、miR-19a-3p、miR-205-5p及let-7b-5p表达与紫杉联合蒽环类化疗方案的敏感性相关。
目的：研究乳腺癌合并腹股沟淋巴结转移患者的临床表现、病理学特点和影响预后的因素。
方法：收集1999年1月至2010年12月收治的17例乳腺癌合并腹股沟淋巴结转移患者的临床资料,分析其临床病理特征和预后影响因素。
结果：17例伴有腹股沟淋巴结转移的乳腺癌患者占同期乳腺癌患者收治总数的0.11%,其中合并其他部位转移15例(88.2%),单纯腹股沟淋巴结转移2例(11.8%)。17例患者均接受了雌激素受体(ER)和(或)孕激素受体(PR)检测,10例(58.8%)阳性,7例(41.2%)阴性。13例患者接受了表皮生长因子受体2(HER-2)检测,其中4例(30.8%)阳性。16例患者接受手术治疗,术中发现9例患者的腋窝淋巴结转移≥4枚。17例患者均接受化疗。中位随访时间为156个月,全组患者的5年生存率为49.9%。单因素分析结果显示,腋窝转移淋巴结≥4枚、ER和(或)PR阴性、辅助化疗周期数≤6个、确诊时分期为Ⅲ、Ⅳ期以及发现乳腺癌至腹股沟淋巴结转移的时间≤36个月为患者无进展生存时间(PFS)的不良预后因素(均P<0.05)。腋窝转移淋巴结≥4枚、ER和(或)PR阴性、辅助化疗周期数≤6个、首次复发为多发远处转移、发现乳腺癌至腹股沟淋巴结转移的时间≤36个月以及合并胸腔积液为患者总生存的不良预后因素(均P<0.05)。多因素分析结果显示,发现乳腺癌至腹股沟淋巴结转移的时间是影响患者无进展生存时间(PFS)的独立预后因素(P<0.05)。
结论：影响乳腺癌合并腹股沟淋巴结转移患者预后的主要因素为腋窝淋巴结转移数目、激素受体状态、辅助化疗周期数、首次复发转移类型、发现乳腺癌至腹股沟淋巴结转移的时间以及是否有胸腔积液。术后定时全面复查、对高危人群及时给予强化治疗对改善患者的预后可能有一定的积极意义,但也需要探索更为合理的个体化综合治疗方案。
Background and purpose:It is difficult to overcome the problem of drug-resistance in breast cancer patients. This study is based on the anti-microtubules drugs(including epothilone B and taxanes), for the aim to analysize the resistant factors including resistant protein and miRNA. First, it was reported that MRP7may contribute to the resistance of epothilone B,so the patients with epothilone B only in one of our phase I clinical trials were enrolled in our study.We detect the expression of MRP7in vivo and hope to find the relationship between epothilone B and MRP7. Second, taxanes based chemotherapy was one of the most common choices in breast cancer treatment. The type of luminal A was only partly sensitive to chemotherapy, including taxanes based chemotherapy. The aim of our study is to find the biomarkers of chemotherapy resistance by detecting miRNAs in serum, which may give direction to clinical treatment choice in the type of luminal A breast cancer patients.
Methods:First, based on the epothilone B phase I clinical trial in our department, we collected blood samples from patients at different time points, to detect the pharmaco kinetic parameters. We want to find the relationship between MRP7expression and epothilone B pharmacokinetics as well as efficacy by detecting MRP7protein expression in cancer tissue and peripheral blood with immunohistochemistry and flow cytometry respectively. Winnonlin pharmacokinetic statistics software was used to make blood drug concentration-time curve fit. To get pharmacokinetic parameters of epothilone B in vivo, the trapezoidal area method was used to estimate AUC. Confidence interval method was used to evaluate the relationship between pharmacokinetic parameters and drug doses. Standard curve regression equation was obtained by regression analysis. Double variable spearman correlation analysis was used between two groups. All inspection was bilateral, with standards of alpha=0.05, P<0.05indicates statistical significance. Secondly, obtain the serum sample of luminal A type breast cancer patients who received anthracycline combined with taxanes (AT) regimen before surgery. Based on the sensitivity differences to AT regimen, sensitive and resistant groups were separated, total RNA in serum was extracted. As a pool,6samples of accurate matching patients were selected in sensitive and resistant groups respectively. After pre-amplification, TaqMan Real-time PCR chip was used to detect differentially expressed miRNAs. Selected38cases from sensitive group, and30cases from drug-resistant group with well-balanced clinical pathologic features. Fluorescence quantitative polymerase chain reaction (PCR) was used to verify the miRNAs with apparent differences from chip screening in a larger sample size. Analyze the results after confirmation and explore the predictive value of these miRNAs in chemosensitivity. RQ manager1.2and Data Asist V2.0software was used to analyze the chip. SPSS16.0software was used for statistical analysis. Statistical description was used to describe the clinical pathological features, t test (Student's t test) was used to analyze measurement data; Mann-Whitney U in nonparametric test was used to analyze the continuous variable. P value was bilateral tested less than0.05was regarded as statistical significance.
Results:First, pharmacokinetic:we found the average fluorescence intensity from peripheral blood MRP7and the pharmacokinetic parameters including AUC (P=0.001), t1/2β (P=0.039), the Cmax (P=0.017) and Cl (P=0.001) were significantly correlated. Negative correlation was found in the MRP7fluorescence intensity and AUC, t1/2β, Cmax, and positive correlation was found both in MRP7fluorescence intensity and positive staining cells with Cl (P=0.026). However, MRP7in tissue does not show obvious correlation with pharmacokinetic parameters. Efficacy:MRP7expression levels in tissue were high in all of the17patients. But for the only one who got partial response (PR), her MRP7expression in tissue was relatively low, and MRP7average fluorescence intensity was relatively weak in peripheral blood. These data showed that MRP7expression may have relationship with efficacy. At the same time, the AUC, tl/2β in the only patient who got response were the highest in the three patients with same dose level, and her Cl was the lowest in all of the17patients. These data indicated that the pharmacokinetic parameters of AUC, tl/2(3and Cl might have correlation with efficacy. Second, based on217differentially expressed microRNAs screened by miRNA chip, we selected9miRNAs which show more apparent differences between the two groups, and gave validation in68cases of type luminal A breast cancer (30cases from resistant group,38cases from sensitive group). Results show that the let-7b, miR-205, miR-19a and miR-27a were obviously different between the two groups. The difference was statistically significant (P<0.05). Among them, miR-19a and miR-27a showed more significant difference with1.56fold between the two groups than the other two miRNAs.
Conclusion:First, MRP7expression may influence drug pharmacokinetic parameters in breast cancer patients, and may have a tendency to affect efficacy. At the same time, there may be correlation between pharmacokinetic and efficacy. Second, miR-27a-3p%miR-19a-3p/、miR-205-5p and let-7b-5p miRNAs in serum of breast cancer patients with luminal A type are associated with chemosensitivity.
Objective To analyze the clinicopathological feature and prognostic factors of breast cancer patients with inguinal lymph node metastasis.
Methods From January1999to December2010,17breast cancer patients with inguinal lymph node metastasis were treated in our cancer center. All of the patients had a history of breast cancer without the other primary cancer. Clinicopathological characteristics, prognostic factors were surveyed.
Results The frequency of breast cancer cases who occurred inguinal lymph node metastasis was0.11%in the period.2patients (11.8%) had inguinal lymph node metastasis only, multi-sites metastases were observed in the remaining15(88.2%) patients. The number of ER and/or PR-positive and negative were10(58.8%) and7(41.2%) respectively, and in the13cases who underwent HER-2test, the number of HER-2-positive was4(30.8%). For the16patients who underwent surgery,9patients were detected metastatic axillary lymph nodes equal or greater than4. All of the17patients were treated with chemotherapy. The median follow-up time was156months. The5year overall survival was49.9%. Univariate analysis revealed that metastatic axillary lymph nodes>4, ER and (or)PR negative, adjuvant chemotherapy<6cycles, disease stage as III/IV at diagnosis and the period from diagnosis of breast cancer to the occurrence of inguinal lymph node metastasis<36months were predictors of shorter PFS (P<0.050). Metastatic axillary lymph nodes>4, ER and (or)PR negative, adjuvant chemotherapy≤6cycles, primary recurrence as multiple distant metastases, the period from diagnosis of breast cancer to the occurrence of inguinal lymph nodes metastasis≤<36months and pleural effusion were predictors of shorter OS (P<0.05).Multivariate analysis revealed that the period from diagnosis of breast cancer to the occurrence of inguinal lymph node metastasis was the only independent prognostic factor concerning PFS(P<0.05).
Conclusions The prognostic factors of breast cancer patients with inguinal lymph node metastasis included the number of metastatic axillary lymph nodes, ER and (or) PR status, the cycles of adjuvant chemotherapy, type of primary recurrence, the period from diagnosis of breast cancer to the occurrence of inguinal lymph node metastasis and pleural effusion. Regular and complete physical examination after surgery as well as prompt intensive treatment for high-risk patients may have positive significance in the treatment of such type of patients, still, a type of more reasonable and individualized treatment must be in need in future.
引文
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