不同原发灶手术方式对原发性乳腺血管肉瘤患者的预后分析  

Prognostic analysis of patients with primary angiosarcoma of the breast comparing surgery on different primary sites

作　　者：宋张骏 张倩 刘奋德 韩若琳 王虎霞 赵静 韩丕华 Song Zhangjun;Zhang Qian;Liu Fende;Han Ruolin;Wang Huxia;Zhao Jing;Han Pihua(Department of Surgical Oncology,Shaanxi People′s Hospital,Xi′an 710068,China;Outpatient department,Beijing Garrison District Haidian No.54 Retirement Center for Retired Cadres,Beijing 100036,China;Department of Breast Disease,Shaanxi Cancer Hospital,Xi′an 710061,China;Graduate Office of Xi′an Medical University,Xi′an 710021,China)

机构地区：[1]陕西省人民医院肿瘤外科,西安710068 [2]北京卫戍区海淀第五十四离职干部休养所门诊部,北京100036 [3]陕西省肿瘤医院乳腺病院,西安7100614 [4]西安医学院研究生处,西安710021

出　　处：《中华转移性肿瘤杂志》2023年第2期120-127,共8页Chinese Journal of Metastatic Cancer

基　　金：陕西省卫生健康科研基金项目(2022A010);陕西省重点研发计划一般项目-社会发展领域(2022SF-010)

摘　　要：目的探讨不同原发灶手术方式对原发性乳腺血管肉瘤(PBA)患者预后的影响。方法通过SEER数据库收集1983—2015年诊断为PBA的女性患者临床资料和生存数据,分为保乳手术组和乳房全切手术组。结合竞争风险模型和1∶1倾向得分匹配(PSM)排除不同手术组患者资料分布不均的干扰,分析不同手术方式对患者生存结局的影响。结果82.3%(135/164)为乳房全切手术组,17.6%(29/164)为保乳手术组,PSM前乳房全切手术患者发生肿瘤特异性死亡的风险更高(P<0.05)。PSM后保乳手术组和乳房全切手术组各为27例,Kaplan-Meier法显示保乳手术组患者生存率更高(P<0.05);Cox单因素回归显示乳房全切手术是患者总体死亡率的危险因素(HR=2.65,95%CI:1.18~5.93,P<0.05);建立竞争风险模型,乳房全切手术组的肿瘤特异性死亡累积发生率依然更高(P<0.05)。结论PBA患者接受乳房全切手术后肿瘤特异性死亡累积发生率高于保乳手术,这为治疗PBA手术方式的选择提供一定的理论依据。Objective To explore the impact of different primary surgical methods on the prognosis of patients with primary breast angiosarcoma(PBA).Methods Through the Surveillance Epidemiology and End Result(SEER)database,the clinical data and survival data of female patients diagnosed with PBA were collected from 1983 to 2015,and divided into the breast-conserving surgery group and the total breast resection surgery group.Combining the competitive risk model and 1:1 Propensity Score Match,the interference of uneven distribution of baseline data of patients in different surgical groups was eliminated,and the different surgical methods on the survival outcome of patients were analyzed.Results Totally 82.3%(135/164)was divided into the breast total surgery group and 17.6%(29/164)was up to the breast-conserving surgery group.Before PSM,the risk of tumor-specific death was higher in patients with total breast surgery(P<0.05).After PSM,there were 27 cases in each of the breast-conserving surgery group and the total breast resection group.The Kaplan-Meier method showed that the breast-conserving surgery group had a higher survival rate(P<0.05).The Cox unifoliate regression showed that total breast resection was a risk factor for the overall mortality of patients(HR=2.65,95%CI:1.18-5.93,P<0.05).By establishing a competitive risk model,the cumulative incidence of tumor-specific deaths in the total breast surgery group was still higher(P<0.05).Conclusions The cumulative incidence of tumor-specific death in PBA patients undergoing total mastectomy was higher than that of breast-conserving surgery,which provides a theoretical basis for the choice of surgical approach for the treatment of PBA patients.

关 键 词：乳腺肉瘤 血管肉瘤 手术方式 预后 SEER数据库 

分 类 号：R737.9[医药卫生—肿瘤]