复发转移性三阴乳腺癌患者进展后生存特征分析  

Survival of Patients with Metastatic Recurrent Triple-negative Breast Cancer

作　　者：彭祖祥 钟晓蓉[2] 王竹[2] 王宇[2] 王艳萍[2] 郑鸿[2,3] 敬静[1] 

机构地区：[1]四川大学华西医院甲状腺乳腺外科,成都610041 [2]四川大学华西医院肿瘤分子诊断研究室国家生物治疗协同创新中心,成都610041 [3]四川大学华西医院肿瘤中心,成都610041

出　　处：《四川大学学报（医学版）》2016年第4期541-546,共6页Journal of Sichuan University(Medical Sciences)

摘　　要：目的分析复发转移性三阴乳腺癌（metastatic recurrent triple-negative breast cancer,mrTNBC）的生存特征并寻找独立影响患者生存的预后因素。方法收集四川大学华西医院收治、经病理组织学证实、在治疗过程中或治疗完成后发生首次复发转移的三阴乳腺癌（triple-negative breast cancer,TNBC）患者的临床病理资料。进展后生存情况采用Kaplan-Meier方法进行分析,单因素预后分析采用log-rank检验,多因素预后分析采用Cox比例风险模型。结果本研究共纳入142例患者,中位随访时间41.9月（5.1~189.5月）,进展后中位生存时间22.0月。单因素分析结果显示：肿瘤直径大小、淋巴结状态、肿瘤TNM分期、无疾病间隔期（disease-free interval,DFI）、复发转移部位的个数、是否脑转移、是否肝转移和进展后治疗模式是进展后生存时间的影响因素。多因素分析结果提示,发生多部位进展（P=0.004）、DFI≤12月（P=0.010）、发生脑转移（P=0.037）和单模式治疗（single-modal therapy,SMT,P〈0.001）是影响mrTNBC患者预后的独立危险因素。在局部复发的患者中,多模式治疗（multi-modal therapy,MMT）比SMT预后更好（进展后3年生存率,53.0%vs.11.4%,P=0.024）,远处转移的患者也有相同的趋势（进展后3年生存率,58.1%vs.29.3%,P=0.003）。结论发生多部位进展、DFI短、发生脑转移均为影响mrTNBC患者生存的危险因素,MMT为其保护因素。Objective To determine factors associated with the survival of patients with metastatic recurrent triple-negative breast cancer（mrTNBC）.Methods Initial metastatic recurrent（during or after therapy）patients with triple-negative breast cancer（TNBC）confirmed by post-operate pathology in the West China Hospital of Sichuan University were followed up.The accumulative survival rates after recurrence were calculated using KaplanMeier method and differences were tested using log-rank tests.Cox proportional hazards regression analyses were performed to identify independent predictors of survival rates.Results A total of 142 patients were included in this study.They were followed up on average 41.9months（range：5.1-189.5months）,and had median post-recurrence survival time of 22.0 months.Tumor diameter,lymph node status,TNM stage,disease-free interval（DFI）,numbers of recurrent lesions,brain metastasis,liver metastasis and the rapeutic patterns were associated with the survival of patients.The Cox proportional hazards regression model identified multi-lesions recurrence（P=0.004）,DFI≤12 months（P=0.010）,brain metastasis（P=0.037）and single-modal therapy（SMT）（P〈0.001）as independent risk predictors of post-recurrence survival.In the patients with local recurrence,multi-modal therapy（MMT）had 53.0%post-recurrence 3-year survival rate compared with 11.4% of SMT（P=0.024）.Similar results were also found in the patients with distant metastases（post-recurrence 3-year survival rate 58.1%for MMT versus29.3%for SMT,P=0.003）.Conclusion Multi-lesions recurrence,short DFI and brain metastasis are independent risk predictors,while MMT is a protective factor for the survival of patients with mrTNBC.

关 键 词：三阴乳腺癌 无疾病间隔期 脑转移 多模式治疗 预后分析 

分 类 号：R737.9[医药卫生—肿瘤]