1837例区域淋巴结转移的乳腺癌患者临床病理多因素预后分析  

A multivaviate analysis of prognosis in 1837 breast cancer patients with positive regional lymph nodes impact of clinilcal pathological factors

作　　者：张亚伟[1] 沈坤炜[1] 沈镇宙[1] 韩企夏[1] 庄传经[1] 相加庆[1] 裘家骥[1] 潘天锡[1] 

机构地区：[1]上海医科大学肿瘤医院外科

出　　处：《上海医学》1999年第1期22-26,共5页Shanghai Medical Journal

摘　　要：目的对区域淋巴结转移的乳腺癌患者进行临床病理多因素预后分析。方法选择２０个可能对区域淋巴结转移的乳腺癌患者预后产生影响的非重复特征的临床病理因素，通过计算机，采用累计生存率及ＣＯＸ多因素分析模型，进行单因素及多因素的预后分析。结果在选取的２０个因素中，月经状况、初潮年龄、病程、活检方式、术后内分泌治疗、活检时间与生存率相关，但多因素分析则无关；而妊娠次数、肿瘤大小、手术方式、内乳淋巴结情况、腋淋巴结转移数目、皮肤累及情况、病理类型、术后化疗、术后放疗、术前放疗是影响区域淋巴结转移患者生存率的独立因素。结论用临床病理资料对区域淋巴结转移的乳腺癌患者进行预后分析，发现局部晚期的乳腺癌患者预后最差；选择性地局部扩大手术范围清扫或探查内乳淋巴结情况不仅对预测预后提供帮助，而且能提高生存率；术后辅助化疗能提高淋巴结阳性乳腺癌患者的生存率；非选择性的内分泌治疗并不能提高生存率。Objective To study the prognosis of breast cancer patients. with regional lymph node metartasis. Methods The data were analyzed in 1837 consecutive breast cancer patients, with positive regional lymph node, twenty individual variables were evaluated statistically using the life table method for univariate analysis and the cumulative survival rate by the computer' Cox multivariate analysis model. Results In univariate analysis, menopausal status, age of menarche, duration before diagnosis, type and time of biopsy, postoperative endocrine therapy predicated disease free period and overall survival. In multivariate analysis, number of pregnancy, tumor size, type of surgery, intramammary lymph node status, number of positive axillary node, skin status, pathologic, pattern postoperative chemotherapy, pre- and post operative radiotherapy were verified to be independent prognostic factors. Conclusion The progosis of patients with locally advanced breast cancer was miserable. Selective extending radical mastecomy could not only provide intramammary lymph node status to predict survival, but also improve the survival rate. Postoperative chemotherapy should be used for patients with positive node to improve survival rate, The role of selective endocrinel therapy to patients with positive lymph node remains to be investigated.

关 键 词：乳腺癌 淋巴结转移 COX模型 肿瘤转移 

分 类 号：R737.9[医药卫生—肿瘤] R73－37[医药卫生—临床医学]