三阴性乳腺癌预后相关因素分析

摘要

Objective To investigate the prognostic factors related to triple-negative breast cancer (TNBC) by analyzing clinicopathologic characteristics,treatment and prognosis.Methods Three hundred and five TNBC patients treated between January 2004 and December 2011 were enrolled and retrospectively reviewed with Kaplan-Meier and Cox proportional hazards models.All patients were females and the age onset were 24-82 years old (the median were 50 years old).Results The follow-up period was 1 to 114 months,with median 38 months.The 5-year disease free survival (DFS) rate was 68％ and overall survival (OS) rate 75％.The peak risk of recurrence occurs within the first 2-3 years after initial treatment of the disease,but distant relapse after this time is much less common.Survival analysis showed that surgery type (x2 =4.030,P =0.045),tumor grade (x2 =8.000,P =0.046),lymph-vascular invasion (x2 =10.386,P =0.001) and lymph node stage (x2 =119.36,P =0.000),TNM stage (x2 =65.961,P =0.000) and treatment plan (x2 =28.371,21.874,32.163,all P =0.000) were statistically related to DFS; while age (x2 =10.226,P =0.006),lymph-vascular invasion (x2 =18.881,P =0.000),lymph node stage (x2 =98.958,P =0.000),TNM stage (x2 =65.342,P =0.000) and type of treatment (x2 =17.862,18.708,31.921,all P =0.000) were related to OS.The lymph nodes stage was prognostic factor related to both DFS and OS.Conclusions TNBC was characterized by poor prognosis and rapid progression.The lymph nodes metastatic status was the most important prognostic factor of TNBC.%目的 分析三阴性乳腺癌(triple-negative breast cancer,TNBC)的临床病理特征、治疗及预后,探索预后相关因素.方法 回顾性分析2004年1月至2011年12月收治的305例TNBC患者的临床及随访资料,患者均为女性,发病年龄24 ～ 82岁,中位发病年龄50岁.通过生存分析确定预后相关因素.结果 患者随访时间1 ～114个月,中位随访时间38个月.患者5年无病生存率为68％,5年总生存率为75％.术后2～3年为复发、转移高峰,几乎所有的复发转移都发生在术后5年内.生存分析提示,与DFS相关的因素为手术方式(x2=4.030,P=0.045)、肿瘤分级(x2=8.000,P =0.046)、瘤栓(x2=10.386,P=0.001)、淋巴结分期(x2=119.36,P=0.000)、TNM分期(x2=65.961,P=0.000)以及治疗情况(x2=28.371、21.874、32.163,均P=0.000).与OS相关的因素包括年龄(x2=10.226,P=0.006)、瘤栓(x2=18.881,P=0.000)、淋巴结分期(x2=98.958,P=0.000)、TNM分期(x2=65.342,P=0.000)以及治疗情况(x2=17.862、18.708、31.921,均P=0.000).DFS和OS都明显相关的预后因素是淋巴结分期,淋巴结转移数目越多的患者预后越差.结论 TNBC预后差,进展快,淋巴结转移状态是影响其预后的最重要因素.