不同分子分型乳腺癌术后复发转移风险及其时间分布规律  

The Time-distribution of Breast Cancer Recurrence after Surgery in Different Molecular Subtypes

作　　者：刘玲玲[1,2] 林芳[1,2] 韩耀风[1,2] 安汉祥[3] 方亚[1,2] 

机构地区：[1]厦门大学公共卫生学院,361102 [2]卫生技术评估福建省高校重点实验室 [3]厦门大学附属第一医院肿瘤科

出　　处：《中国卫生统计》2017年第1期7-10,14,共5页Chinese Journal of Health Statistics

基　　金：厦门市科技计划项目(3502Z20143006)

摘　　要：目的探讨不同分子分型乳腺癌术后复发转移风险及其时间分布规律。方法收集345名2004年1月1日-2012年12月31日于厦门市某三甲医院手术治疗的女性乳腺癌患者资料,根据免疫组化结果将乳腺癌分成Luminal A、Luminal B、BCL和Her-2/neu 4种分子分型,随访其复发转移情况,末次随访时间为2014年9月30日。用寿命表法估计不同分子分型乳腺癌患者未复发转移生存率和复发转移风险,同时用log-rank检验进行组间比较,进一步地,采用Cox回归分析其复发转移的影响因素。结果术后总复发转移率为36.5%,Her-2/neu、Luminal B、Luminal A和BCL型患者的复发转移率依次为47.89%、35.26%、32.10%和29.73%。单因素和多因素结果均表明,分子分型影响患者术后复发转移(P<0.05),Her-2/neu型患者的术后复发转移风险最高,是Luminal A的2.27倍(P<0.05)。BCL型的术后复发转移风险呈三峰分布,其余均为双峰型;Her-2/neu和BCL型首次高峰出现在术后第1年,Luminal A和Luminal B型则为第2年;4种分型的另一高峰为术后第5年;BCL型在术后第3年还出现一次小高峰。结论分子分型对乳腺癌术后复发转移具有预测价值,且不同分子分型患者术后复发转移风险不同,其时间分布呈一定规律性。Objective To evaluate the risk and probe time-distribution of breast cancer recurrence in difference molecular subtypes. Methods A total of 345 breast cancerwomenwho accepted surgery at a hospital in Xiamen betw een January 2004 and December 2012 were classified by immunohistochemical assays into four molecular subtypes as follow s： Luminal A、Luminal B、BCL and Her-2 / neu. All patientswere follow ed up until September 30. Data on recurrence or metastasiswere collected. Life table analysiswas used to calculate disease-free survival rates and recurrence or metastasis risk. The survival rates among different molecular subtypeswere compared by log-rank test. Furthermore,Cox proportional hazard regression modelwas used to determine prognostic factors. Results The total rate of recurrence or metastasiswas 36. 5%,Her-2 / neu、Luminal B、Luminal A and BCLwere 47. 89% 、35. 26% 、32. 10% and 29. 73%. Univariate and multivariate analysis results show ed that significant differences in recurrence or metastasiswere found among four molecular subtypes（ P〈0. 05）,Her-2 / neuwas more likely to occur recurrence or metastasis,w hich riskwas 2. 27 than Luminal A（ P〈0. 05）. Therewere three peaks in recurrence and metastasis curve of BCL,w hile otherswere tw o peaks; Her-2 / neu appeared fist peak at first year after surgery,Luminal A and Luminal B at second year; Therewas a peak occurred at fifth year of all subtypes; BCL appeared a peak at third year. ConclusionMolecular subtypes of breast cancerwas an important prognostic factor. Recurrence or metastasis rate vas variedwith molecular subtype,and took on some characteristics. Patientswith Her-2 / neu or BCLwere in higher relapse risk than others,w hose recurrence and metastasiswere occurred earlier. Clinicians should develop individualized intervention plans according to molecular subtypes in order to reduce recurrence.

关 键 词：乳腺癌 分子分型 复发转移 风险 时间分布 

分 类 号：R737.9[医药卫生—肿瘤]