腋淋巴结阳性Ⅰ、Ⅱ期乳癌预后因素分析  

Prognostic factors in node-positive Ⅰ、Ⅱ stage breast cancer patients receiving adjuvant chemotherapy

作　　者：李彦博[1] 宋三泰[1] 汤仲明[1] 江泽飞[1] 刘晓睛[1] 徐建明[1] 

机构地区：[1]解放军307医院,北京100039

出　　处：《中国肿瘤临床与康复》1999年第5期1-5,共5页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的确定具有高危复发转移倾向的病人．给他们实施积极而合理的治疗，以改善他们的预后。方法回顾性地分析了188例脏窝淋巴结阳性，术后接受CMFVP辅助化疗的Ⅰ、Ⅱ期乳癌病人。观察的终点指标为5年无病生存率（DFS）和总生存率（OS）。考虑分析的因素包括年龄、月经状态、病程、原发肿瘤大小、雌激素受体状态、阳性腑窝淋巴结数量。结果对DFS和OS有预后意义的两个因素是原发肿瘤大小和阳性腋窝淋巴结数量。传统的T1和T2之间比较，预后无明显差别。但把肿瘤的大小由2cm改为3cm为观察界限，肿瘤的大小将是非常明显的预后因素。T≤3cm的病人的5年DFS和OS分别是71．3％和83．2％，而T＞3cm的病人5年DFS和OS分别是48．3％（P＜0．01）和62．6％（P＜0．01）。将这两个不良的预后因素按T＞3cm和N＋≥4把病人分成三组，Ⅰ组是没有以上两个因素；Ⅱ组是只有其中一个不良的因素；Ⅲ组是同时具有两个不良因素。三组病人的5年DFS分别为78．3％、59．2％、28．4％（P＜0．05）。5年OS分别为86．2％、74．3％、40．0％（P＜0．05）。结论我们的分析证实了传统预后指标的意义，同时也发现，肿瘤直径＞3cm是一个不良的预后因素，它不依赖于阳性淋巴结的数目．这提示我们在设计和分析临床试验。Objective To identify patients who are at high risk of relapse and metastases and to offer them a more optimal and aggressive treatment and improve their prognosis. Methods A retrospective analysis of prognostic factors was performed in 188 consecutive node-positive (N+ ) Ⅰ、Ⅱ stage breast cancer patients treated with CMFVP adjuvant chemotherapy. Actuarial disease-free survival (DFS) and overall survival (OS) were determined according to age, menopausal status, size of primary tumor(T). tumor location, hormonal receptor status .number of N+. Results Two prognostic factors for DFS and OS were number of N+ and T size. A comparison between traditionally classified TI and T2 patients revealed no significant difference, but when the cut-off point was shifted from 2cm to 3 cm, T size represented a highly significant prognostic factor. In patients with T less than or equal to 3cm 5-year DFS was 71. 3 % and 5-year OS was 83. 2 %,while in patients with T greater than 3cm,the respective values were 48. 3 % (P<0. 001 )and 62. 6 % (P<0. 001 ). Two adverse variables, T greater than 3cm,number of N+ greater or equal to 4,were used to divide our patients into three subsets with significantly different DFS: Group Ⅰ,with none of the above factors; Group Ⅱ, with only one factor present; and Group Ⅲ,with two factors present, 5-year DFS were 78. 3%, 59. 2 % and 28.4 %, respectively. (P<0. 05 ); 5-year OS were 86. 2 %. 74. 3 %, 40. 0 %, respectively, (P<0. 05 ). Conclusion Our results confirm the great value of classical prognostic factors in node-positive Ⅰ、Ⅱ stage breast cancer patients receiving adjuvant chemotherapy and our data indicate that the diameter of tumor exceeding 3cm is an adverse prognostic factor,no matter how many number of N+ present,and tumors with diameter exceeding 3 cm deserves consideration in analysis and prospective trial.

关 键 词：乳腺癌 预后 因素分析 

分 类 号：R737.907[医药卫生—肿瘤]