影响乳腺导管癌进展后生存时间的Cox多因素分析  

Multivariate Cox Regression Analysis of Survival Time After Progression for Mammary Induct Carcinoma

作　　者：何妮[1] 彭康强[1] 周露茜[2] 吕宁[1] 黄职妹[1] 吴沛宏[1] 伍尧泮[1] 

机构地区：[1]中山大学肿瘤防治中心//华南肿瘤学国家重点实验室//肿瘤医学协同创新中心影像与微创介入中心,广东广州510060 [2]广州医科大学第一附属医院呼吸疾病国家重点实验室//呼吸疾病研究所,广东广州510060

出　　处：《中山大学学报（医学科学版）》2014年第1期144-151,共8页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金面上项目(30973418);广东省科技计划项目(2009B030801010);广东省自然科学基金(S2012010009103)

摘　　要：【目的】评估通过不同预后因子预测乳腺导管癌患者转移后生存时间的可行性。【方法】1990年至2005年在中山大学肿瘤防治中心就诊的乳腺导管癌患者,在过去20余年随访中证实发生转移者入组回顾性研究。按不同的临床预测因子分组,记录中位无进展生存时间(PFS),中位进展后生存时间(POS)及中位总生存时间(OS),评估通过初诊信息、PFS及转移位点3方面信息推测一个乳腺导管癌患者的POS的可能性。【结果】1 050个入组患者,中位PFS为39个月,中位POS为29个月,中位OS为67个月。肿瘤初诊情况包括病人特征(年龄、月经)、肿瘤特点(大小、核分级、分子亚型、激素受体、Her2受体、淋巴结转移情况)以及初诊肿瘤治疗方案可导致中位PFS/POS/OS不同。2000-2005年就诊的患者其中位POS长于其他时间(P=0.000),但中位PFS与OS的差别无统计学意义(P>0.05)。PFS亚组和进展情况亚组(局部复发及转移位点)的患者的中位POS明显不同(P<0.000),故我们认为可通过患者的PFS及进展情况推测患者的进展后生存时间,进而推断总生存时间。【结论】POS与PFS及转移位点密相关。结合初诊信息(肿瘤大小、核分级、淋巴结转移及初诊是否接受手术治疗),可帮助临床医生推断患者准确POS区间,选择最为适合的治疗方案。[Objectives] To estimate the possibility to predict overall survival time after progression （POS） for mammary induct carcinoma patient with different prognostic factors. [ Methods ] From 1990 to 2005, mammary induct carcinoma patients who were confirmed metastasis on over 20 years follow-up were included in this retrospective analysis. They were treated and followed up at Sun Yat-sen University Cancer Center. We recorded the median progression-free time（PFS）, median overall survival time after progression （POS） and median overall survival time（OS） grouped by different prognostic factors. We also estimated the possibility to predict the POS for one breast cancer patient by three factors ： first diagnose message, PFS and metastatic site. [ Results ] From 1 050 women, the median PFS was 39 months, the median POS was 29 months, and the median OS was 67 months. The median PFS/POS/OS was different in which grouped by first diagnose messages including patient feature （age, menopausal status）, tumor characteristics （size, histological grading, molecular subtype, hormonal receptor status, Her2 receptor status, axillary lymph node metastasis） and the treatments for primary tumor. The median POS who diagnosed in the period of 2000-2005 group was longer than others （P = 0.000）, but the median PFS and OS were the same （P 〉 0.05）. And the median POS was obviously different in subgroups with different PFS and progression（local recurrence and metastatic site） （P 〈 0.000）. So, we found it was possibility to predicted POS, and then to OS with them （Multiple Cox analysis, P 〈 0.05）. [Conclusions] POS was closely related to PFS and metastatic site. Combining with primary tumor information （tumor size, histological grading, molecular subtype, lymph node metastasis and surgery therapy）, it was very useful for doctor to choose an appropriate treatment plan for one progressive breast cancer patient with accurate POS range.

关 键 词：乳腺导管癌 预测 无进展生存时间 进展后生存时间 总生存时间 

分 类 号：R73[医药卫生—肿瘤]