青年女性乳腺癌临床病理学特点及预后相关因素分析

摘要

目的 探讨青年女性乳腺癌临床病理学特征,分析临床治疗选择与预后的关系.方法 回顾性分析自2008年1月至2014年12月北京大学第一医院乳腺疾病中心经治的乳腺癌病例,比较同期青年组(<35岁)与年长组(≥35岁)的临床病理学差异,探讨青年女性乳腺癌临床病理学特征与预后之间的相关性,绘制Kaplan-Meier曲线计算生存期,通过Log-rank检验进行单因素分析,并行Cox模型多因素分析,应用后退法筛选影响生存的危险因素.结果 青年女性乳腺癌110例,占全部乳腺癌的5.7%,中位年龄32(21~34)岁,与同时期≥35岁病人相比较,两组Luminal A型、Luminal B型(HER2阴性)分布差异有统计学意义(P<0.001).青年女性乳腺癌临床分期、原位癌发病率、HR阳性及HER2阳性乳腺癌所占比例与≥35岁病人差异均无统计学意义.青年女性乳腺癌病人选择保乳手术、全乳房切除联合成形手术的比例与≥35岁病人差异具有统计学意义(P<0.001).中位随访时间31.5(8~78)个月,5年存活率93.3%,5年无进展存活率89.3%.单因素及多因素分析显示,青年女性乳腺癌无进展生存期与N分期(P<0.001)、M分期(P<0.001)相关,总生存期与N分期相关(P<0.001).结论 青年女性乳腺癌具有独特的临床病理学特点,在强化内分泌治疗的同时应注意生育保护,由于对外形、生活质量要求更高,青年女性乳腺癌的外科手术方式需要个体化选择.%Objective To explore the clinical and pathological characteristics of breast cancer in young women(<35 years old)and to analyze their association with treatment and prognosis. Methods The records of 110 breast cancer in young women treated from January 2008 to December 2014 were reviewed. Statistical methods were used for analyzing the correlation between clinical and pathological characteristics such as T-stage, N-stage, IHC (Immunohistochemistry) and the morbidity as well as prognosis. The clinical and pathological characteristics of breast cancer in young women were compared with patients ≥35years using the χ2 test. Kaplan-Meier curves were reported for OS (overall survival) and PFS (progression-free survival), and the log-rank test was used to compare the difference in groups. Cox proportional models were fitted for multivariate analysis. Results All of the patients were women and the median age was 32 (21 to 34)-year old, accounted for 5.71%(110/2189) of the breast cancer treated at the same period. The morbidity of Luminal A-like and Luminal B-like(HER2 negative) in <35-year group were higher than ≥35-year group(P<0.001). Patients<35 years chose breast-conserving or mastectomy combined reconstruction surgery were much more than older group(P<0.001). The median follow-up duration of breast cancer in young women was 31.5 months, the 5-year OS rate was 93.3%and the 5-year PFS rate was 89.3%. It is concluded that the N-stage(P<0.001)and M-stage(P<0.001)were the influencing factors of the PFS by multivariate Cox regression analysis. The N-stage(P<0.001)was the influencing factor of OS. Conclusion Breast cancer in young women had special clinical and pathological characteristics. The endocrine therapy should be strengthened as well as protecting fertility. Patients<35 years demanded high quality of life and appearance, and the option of surgical treatment should be personalized.