75例老年乳腺癌患者新辅助化疗疗效及预后分析  

Neoadjuvant chemotherapy efficacy and prognosis analysis in 75 elderly patients with breast cancer

作　　者：周立艳[1] 史业辉[1] 贾勇圣[1] 刘晓东[1] 佟仲生[1] 

机构地区：[1]天津医科大学肿瘤医院乳腺肿瘤内科国家肿瘤临床医学研究中心乳腺癌防治教育部重点实验室天津市肿瘤防治重点实验室,300060

出　　处：《中华乳腺病杂志（电子版）》2014年第3期20-26,共7页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：天津市重大课题专项项目(12ZCDZSY16200)

摘　　要：目的 探讨老年乳腺癌患者的临床病理学特征、新辅助化疗疗效及预后的相关影响因素.方法 回顾性分析2003年1月至2008年12月本院收治的75例年龄≥65岁且接受新辅助化疗的乳腺癌患者的临床及病理资料.采用×^2检验或Fisher确切概率检验分析不同临床病理因素与老年乳腺癌患者预后的关系,采用Kaplan-Meier法进行生存分析,Log-Rank检验进行预后单因素分析,COX回归模型进行多因素分析.结果 75例患者临床总有效率（ORR）为86.67％ （65/75）,pCR为18.67％（14/75）.单因素分析发现原发肿瘤直径是老年乳腺癌患者新辅助化疗达pCR的影响因素（×^2=4.08,P=0.043）.老年乳腺癌患者5年DFS率和OS率分别为70.90％、81.30％.单因素分析显示,影响老年乳腺癌患者预后的因素包括合并疾病、TNM分期、病理类型、激素受体状态、不同新辅助化疗方案及pCR（×^2=4.18、3.92、6.50、13.04、6.29、7.18,P=0.041、0.048、0.011、0.000、0.043、0.007）.多因素分析显示,激素受体阴性是影响老年乳腺癌患者DFS的独立危险因素（OR=3.51,95％ CI：1.19 ～ 10.29,P=0.022）,合并疾病是OS的独立影响因素（OR=0.14,95％ CI：0.04～0.44,P=0.001）.结论 老年乳腺癌患者具有特殊的临床特征和独立的预后因素,应综合评价病情,实现个体化治疗.Objective To investigate the clinicopathological characteristics,neoadjuvant chemotherapy efficacy and the prognostic factors in elderly patients with breast cancer.Methods The clinicopathologic data of 75 breast cancer patients at the age of ≥65 years who underwent neoadjuvant chemotherapy in our hospital from January 2003 to December 2008 were analyzed retrospectively.×^2 or Fisher test was used to analyze the correlation between different clinicopathological factors and the prognosis of elderly breast cancer,Kaplan-Meier was used for survival analysis,and Log-Rank and COX regression model were used for univariate and multivariate analysis respectively.Results The overall response rate （ORR） of 75 patients was 86.67% （65/ 75） ; pathologic complete response （pCR） rate was 18.67% （14/75）.Univariate analysis showed that primary tumor diameter was an independent influencing factor of neoadjuvant chemotherapy （×^2 =4.08,P =0.043）.The 5-year disease-free survival （DFS） rate and 5-year overall survival （OS） rate was 70.90% and 81.30%,respectively.Univariate analysis showed that the prognostic factors in elderly breast cancer patients included comorbidity,clinical stage,histological type,hormonal receptor status,different neoadjuvant chemotherapy and pC R（×^2 =4.18,3.92,6.50,13.04,6.29,7.18,P =0.04 1,0.048,0.011,0.000,0.043,0.007）.Multivariate analysis demonstrated that negative hormonal receptor status was an independent risk factor for DFS in elderly breast cancer patients （OR =3.51,95% CI：1.19-10.29,P =0.022）.And the co-morbidity was an independent prognostic factor for OS （OR =0.14,95% CI：0.04-0.44,P =0.001）.Conclusion Elderly breast cancer patients have specific clinical characteristics and independent prognostic factors,so it is necessary to perform the overall evaluation of the patients＇ conditions and give the individualized therapy accordingly.

关 键 词：乳腺肿瘤 老年人 化学疗法 辅助 治疗结果 预后 

分 类 号：R737.9[医药卫生—肿瘤]