发病年龄对乳腺癌保留乳房治疗后长期生存的影响  

Long-term recurrence rate and survival in different aged patients with breast cancer undergoing breast conserving therapy

作　　者：王立泽[1] 李金锋[1] 王天峰[1] 解云涛[1] 范照青[1] 何英剑[1] 欧阳涛[1] Wang Lize;Li Jinfeng;Wang Tianfeng;Xie Yuntao;Fan Zhaoqing;He Yingjian;Ouyang Tao(Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Breast Cancer Center,Peking University Cancer Hospital&Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所乳腺癌预防治疗中心,恶性肿瘤发病机制及转化研究教育部重点实验室,100142

出　　处：《中华外科杂志》2021年第2期127-133,共7页Chinese Journal of Surgery

摘　　要：目的探讨年龄对乳腺癌患者保留乳房治疗后长期复发及生存结局的影响。方法从北京大学肿瘤医院乳腺癌预防治疗中心数据库中回顾性收集1999年12月至2014年12月2778例原发性乳腺癌保留乳房治疗病例的资料,中位年龄47岁(范围:21~91岁)。根据发病年龄将患者分为≤40岁组(677例)与>40岁组(2101例),比较两组患者的临床特征。采用Kaplan-Meier法绘制生存曲线,并用Log-rank法比较两组局部复发率、无远处转移动生存(DDFS)、无病生存(DFS)及乳腺癌特异性生存(BCSS),采用Cox比例风险模型分析复发及生存的预后因素。结果≤40岁组和>40岁组的激素受体阳性比例(490/677比1581/2101,χ^(2)=6.981,P=0.030)、腋窝淋巴结阳性比例(314/677比713/2101,χ^(2)=34.966,P<0.01)、T1期比例(301/677比1160/2101,χ^(2)=37.660,P<0.01)、接受新辅助化疗比例(413/677比1010/2101,χ^(2)=34.272,P<0.01)的差异均有统计学意义。中位随访102个月。≤40岁组和>40岁组10年局部复发率差异无统计学意义(2.5%比1.6%,P=0.147)。≤40岁组和>40岁组10年DDFS率分别为90.6%和95.3%(P<0.01),10年DFS率分别为86.5%和91.1%(P=0.001),10年BCSS率分别为91.0%和93.7%(P=0.105)。年龄不是局部复发的独立预后因素(P>0.05);淋巴结状态(阳性比阴性,HR=2.73,95%CI:1.94~3.84,P<0.01)、年龄(≤40岁比>40岁,HR=1.73,95%CI:1.24~2.42,P=0.001)、肿瘤最大径(>2 cm比≤2 cm,HR=1.61,95%CI:1.14~2.28,P=0.001)是DDFS和DFS的独立预后因素;激素受体状态(阳性比阴性,HR=0.54,95%CI:0.39~0.74,P<0.01)、淋巴结状态(阳性比阴性,HR=2.94,95%CI:2.12~4.07,P<0.01)、肿瘤最大径(>2 cm比≤2 cm,HR=1.45,95%CI:1.05~2.01,P=0.025)是BCSS的独立预后因素。结论≤40岁与>40岁乳腺癌患者保留乳房治疗后局部复发风险相似,前者长期生存劣于后者。Objective To examine the difference of long-term recurrence rate and survivals between the young patients and the old patients undergoing breast conserving therapy(BCT).Methods Women with primary invasive breast cancer receiving BCT between December 1999 and December 2014 were selected retrospectively from the database of Breast Cancer Center,Peking University Cancer Hospital&Institute.The median age of all patients was 47 years(range:21 to 91 years).The cases were categorized according to age at diagnosis into two subgroups:the≤40 years group and the>40 years group.A total of 2778 patients were included:677 patients in the≤40 years group and 2101 patients in the>40 years group.Clinicopathological characteristics between two groups were compared.The recurrence rate and survival were calculated using the Kaplan-Meier method.The differences of outcomes were compared in different aged groups using the Log-rank test.Factors affecting local recurrence,distant disease-free survival(DDFS),disease-free survival(DFS),and breast cancer-specific survival(BCSS)were assessed by multivariable Cox proportional hazard models.Results Proportions of T1(301/677 vs.1160/2101,χ^(2)=37.660,P<0.01),involved lymph node(314/677 vs.713/2101,χ^(2)=34.966,P<0.01)hormone receptor-negative(490/677 vs.1581/2101,χ^(2)=6.981,P=0.030)and neoadjuvant chemotherapy(413/677 vs.1010/2101,χ^(2)=34.272,P<0.01)in the≤40 years group were higher than that in the>40 years group.Median follow-up duration was 102 months.No significant difference in 10-year local recurrence was found between the two groups(2.5%vs.1.6%,P=0.147).Ten-year DDFS rate in the≤40 years group and in the>40 years group was 90.6%and 95.3%,respectively(P<0.01).Ten-year DFS rate in the≤40 years group and in the>40 years group was 86.5%and 91.1%,respectively(P=0.001).Ten-year BCSS rate in the≤40 years group and in the>40 years group was 91.0%and 93.7%,respectively(P=0.105).Age was not the prognosis factor of local recurrence.Lymph node status(positive vs.negative:HR=2.73,95%

关 键 词：乳腺肿瘤 乳房切除术 区段 发病年龄 复发 生存 

分 类 号：R737.9[医药卫生—肿瘤]