35岁以下三阴性乳腺癌临床病理特征及预后分析  

Clinicopathological features and prognosis of very young women(<35 years) with triple-negative breast cancer

作　　者：陈怡安 贾红燕[2] 张萌萌 王斌[2] 李睿[1] 钟晓捷[3] 黄媚 李炘正[4] CHEN Yi-an;JIA Hong-yan;ZHANG Meng-meng;WANG Bin;LI Rui;ZHONG Xiao-jie;HUANG Mei;LI Xin-zheng(the First Clinical Medical School, Shanxi Medical University, Taiyuan 030001, Shanxi, CHINA;Department of General Surgery, the First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, CHINA;Department of Breast Surgery, Hainan General Hospital, Haikou 570311, Hainan, CHINA;Second Department of Breast Surgery, Shanxi Provincial Cancer Hospital, Taiyuan 030001, Shanxi, CHINA)

机构地区：[1]山西医科大学第一临床医学院,山西太原030001 [2]山西医科大学附属第一医院普外科,山西太原030001 [3]海南省人民医院乳腺外科,海南海口570311 [4]山西省肿瘤医院乳腺二科,山西太原030001

出　　处：《海南医学》2019年第13期1657-1663,共7页Hainan Medical Journal

基　　金：山西省科学技术厅青年科技研究基金(编号:201801D221425)

摘　　要：目的分析影响 35岁以下三阴性乳腺癌患者的预后因素。方法回顾性分析来自山西省肿瘤医院、山西医科大学第一附属医院、海南省人民医院确诊于2002-2016年,确诊年龄≤35岁的女性三阴性乳腺癌患者临床资料,排除既往恶性肿瘤病史且临床资料及随访记录不全的患者,共105例患者纳入研究,其中确诊年龄≤25者19例,26~35岁者86例。由临床病历及门诊随访、电话访问获得患者的信息。使用Kaplan-Meier法计算无病生存率(DFS)及总生存率(OS),Cox比例风险模型评估风险比(hazard ratio,HR)及其相关的 95%置信区间(95% confidential interval,95%CI)。结果确诊年龄≤25岁与26~35岁患者在临床病理学特征及治疗方式的选择上差异均无统计学意义(P>0.05),生存分析结果显示两者的DFS、OS比较差异亦无统计学意义(P>0.05);选择不同术式的患者间DFS、OS比较差异均无统计学意义(P>0.05);初潮年龄≤12岁的患者DFS及OS明显低于初潮年龄>12岁的患者,差异均有统计学意义(P<0.05);多因素分析结果显示,初潮年龄(HR 0.697 4,95%CI 0.563 4~0.863 1)、妊娠相关性(HR 2.673 9,95%CI 1.158 1~6.174 1)、淋巴结阳性(HR 4.915 4,95%CI 2.377 4~10.162 7)是影响患者DFS的独立预后因素;影响OS的独立预后因素为初潮年龄(HR 0.598 8,95%CI 0.462 6~0.775)、淋巴结阳性(HR 7.751 9,95%CI 2.923 0~20.559)。结论≤25岁与26~35岁的女性三阴性乳腺癌患者在临床病理学特征及预后上无差异,初潮年龄、妊娠相关性及淋巴结阳性是影响患者预后的独立因素。应当进一步探究生殖因素与年轻三阴性乳腺癌患者间的预后关系。Objective To compare the clinicopathological features and prognosis of very young women (<35years) with triple-negative breast cancer, and to analyze the prognostic factors of very young women (<35 years) with tri-ple-negative breast cancer. Methods The clinical data of 105 very young women (<35 years) with triple-negativebreast cancer, excluding patients with previous malignancies and incomplete clinical data and follow-up records, fromShanxi Provincial Cancer Hospital, First hospital of Shanxi Medical University, Hainan General Hospital between 2002and 2016 were retrospectively analyzed. Among of the patients, 19 patients were diagnosed with age ≤25 years and 86patients between 26 and 35 years old. The clinical data included the clinical medical records and personal interview. Thedisease-free survival (DFS) and overall survival (OS) were calculated by Kaplan-Meier method, and the Cox proportion-al hazard model was used for multivariate analysis. Results There were no significant differences in the clinicopatho-logical features and treatment options between the patients diagnosed of age ≤25 years and 26~35 years old (P>0.05).Survival analysis showed there was no significant difference between the two age groups in DFS and OS (P>0.05). Sub-group analysis found that there was no significant difference in the DFS and OS between patients with different surgicalmethod, and the same trend was observed in both the two age groups (P>0.05). DFS and OS in patients with menarcheage≤12 years were significantly lower than those with menarche age >12 years (P<0.05). Multivariate analysis showedthat menarche age (HR 0.697 4, 95% CI 0.563 4-0.863 1), pregnancy-related (HR 2.673 9, 95% CI 1.158 1-6.174 1),and lymph node positive >3 (HR 4.915 4, 95 % CI 2.377 4-10.162 7) were independent prognostic factors for DFS inpatients;and independent prognostic factors affecting OS: age at menarche (HR 0.5988, 95% CI 0.462 6-0.775), pregnancy-related (HR 2.305 2, 95% CI 0.973 9-5.456), lymph node-positive (HR 7.751 9), 95% CI 2.923 0

关 键 词：三阴性乳腺癌 年轻乳腺癌 保乳治疗 临床病理特征 预后 

分 类 号：R737.9[医药卫生—肿瘤]