保乳治疗对年轻三阴性乳腺癌患者预后的影响

摘要

Objective:To evaluate the outcomes of women aged under 35 years with triple-negative (TN) breast cancer (BC) who underwent breast-conserving surgery (BCS). Methods:The medical records of 126 patients aged under 35 years who underwent BCS in the Tianjin Medical University Cancer Institute and Hospital between January 2000 and December 2009 were retrospectively reviewed. On the basis of immunohistochemical methods, the patients were divided into TN and non-TN groups. The clinical features between the groups were compared to clarify the prognostic significance of TNBC. Results:The TN group was significantly associated with young age (P=0.029), early recurrence and metastasis (P=0.041), as well as high histological grade (P=0.020). Five-year recurrence rates were 14.3%and 4.4%in the TN and non-TN groups, respectively (P=0.048). The distant metastasis rate between the two groups was 14.3%vs. 12.1%(P=0.731), and the overall survival (OS) rate was 91.4%vs. 95.6%(P=0.349). Multivariate analysis was performed, and the recurrence rate was associated with histological grade (HR=10.686, P=0.019). TN was not the risk factor for local failure (HR=3.469;P=0.064). The factors associated with OS were TNM stage (HR=3.503, P=0.001) and histological grade (HR=5.472, P=0.020). Conclusion:The TN group exhibited earlier recurrence and metastasis, as well as higher recurrence rates, than those of the non-TN group. However, there were no significant differences in the distant metastasis rate and OS between TN and non-TN groups. Thus, TNBC should not be contraindicated for breast conservation.%目的：探讨保乳手术对年龄在35岁以下三阴性乳腺癌患者预后的影响。方法：回顾型分析2000年1月至2009年12月天津医科大学肿瘤医院收治126例行保乳手术的年轻乳腺癌患者的临床资料，根据免疫组织化学法将患者分为三阴性乳腺癌及非三阴性乳腺癌两组，比较其临床病理学特征及生存情况。结果：在接受保乳治疗的年轻患者中，三阴性乳腺癌患者的发病年龄早（P=0.029）、复发转移时间早（P=0.041）、组织学分级高（P=0.020）。三阴组和非三阴组5年局部复发率分别为14.3%vs.4.4%（P=0.048），5年远处转移率分别为14.3%vs.12.1%（P=0.731），总生存率分别为91.4%vs.95.6%（P=0.349）。Cox比例风险模型多因素分析显示组织分级是局部复发的独立预后因素（HR=10.686，P=0.019），三阴性并不是局部复发的独立预后因素（HR=3.469， P=0.064）。肿瘤分期是生存的独立预后因素（HR=3.503，P=0.001），组织学分级较高的患者死亡风险亦增高（HR=5.472，P=0.020）。结论：保乳术后三阴性乳腺癌年轻患者复发转移时间早，局部复发率较高，而其远处转移率和总生存率与非三阴性乳腺癌患者比较并无显著性差异。三阴性乳腺癌年轻患者仍可接受保乳治疗。