保乳手术在乳腺癌不同分子亚型患者中的临床疗效对比及其术后复发因素的分析  

Clinical Efficacy of Breast-preserving Surgery in Patients with Different Molecular Subtypes of Breast Cancer and Its Postoperative Recurrence Factors

作　　者：纪璟 姜鹏[1] 王汉晋[1] JI Jing;JIANG Peng;WANG Hanjin(Department of Breast Surgery,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing,Jiangsu 210006,China)

机构地区：[1]南京医科大学附属南京医院乳腺外科,江苏南京210006

出　　处：《华南国防医学杂志》2020年第9期626-630,646,共6页Military Medical Journal of South China

基　　金：南京市科技局重点项目(ZKX18027)。

摘　　要：目的探讨保乳手术在乳腺癌不同分子亚型患者中的临床疗效对比及其术后复发的影响因素。方法回顾性分析2008-12/2013-12月在作者医院进行保乳术治疗的342例乳腺癌患者的临床资料,根据免疫组织化学结果分为Luminal A组(n=82)、Luminal B1组(n=128)、Luminal B2组(n=35)、人类表皮生长因子受体2(human epidermal growth factor receptor-2,HER 2)组(n=22)、三阴性组(n=75)。随访患者术后复发转移情况,采用Kaplan-Meier法绘制两组患者术后生存曲线,比较不同分子亚型患者5年无复发生存期和总生存期,并采用单因素分析和Cox多因素回归分析筛选影响患者术后复发的危险因素。结果截止随访结束,生存者304例(88.89%),死亡38例(11.11%),其中无病生存者280例(81.87%),复发转移者62例(18.13%)。术后1年不同分子分型乳腺癌患者总生存率差异无统计学意义(P>0.05);术后3年、5年不同分型乳腺癌患者总生存率差异具有统计学意义(P<0.05);HER 2过表达型患者术后3年、5年生存率明显低于其他分子分型患者(P<0.05)。不同分子分型患者术后1年、3年、5年的无复发生存率比较差异具有统计学意义(P<0.05);HER 2组患者术后无复发生存率明显低于其他分子分型患者(P<0.05)。Cox风险回归模型分析显示年龄(OR=1.553,95%CI;1.164~2.071)、淋巴结转移数目(OR=1.305,95%CI;1.019~1.670)和分子分型(OR=2.208,95%CI;1.054~2.903)是影响患者保乳术后复发的重要危险因素;放疗是(OR=0.333,95%CI;0.165~0.672)影响保乳术患者术后复发的保护因素(P<0.05)。其中患者年龄与术后复发呈负相关,淋巴结转移数目≥4枚术后复发几率高于淋巴结转移数目<4枚的患者,HER 2阳性患者保乳术后复发几率明显高于其他分子亚型患者(P<0.05)。结论不同分子分型对预测乳腺癌预后有重要意义,其中Luminal型预后较好,HER 2阳性型预后较差,其中年龄、淋巴结状态和分子分型是影响患者保乳术后�Objective To investigate the comparison of clinical efficacy of breast-preserving surgery in patients with different molecular subtypes of breast cancer and the influence factors of postoperative recurrence.Methods A total of 342 patients with breast cancer who underwent surgery in author′s hospital from December 2008 to December 2013 were collected.According to the results of immunohistochemistry,the patients were divided into Luminal A group(n=82),Luminal B1 group(n=128),Luminal B2(n=35),human epidermal growth factor receptor-2(HER 2)group(n=22),three negative group(n=75).The postoperative recurrence and metastasis of patients were followed-up.The postoperative survival curve of patients were drawn by Kaplan-Meier method,the 5 years recurrence-free survival and total survival of different subtypes patients were compared,and the risk factors affecting recurrence after surgery were studied with an intergroup single-factor analysis and Cox multi-factor regression analysis.Results By the end of follow-up,304(88.89%)patients survived and 38(11.11%)patients died,and 280(81.87%)patients were recurrence-free and 62(18.13%)patients had recurrent.There was no significant difference in the total survival rate of patients with different molecular subtypes breast cancer in 1 year after surgery(P<0.05),the total survival rate of patients with different breast cancer subtypes in 3 years and 5 years after surgery were significant differences(P<0.05);the 3-and 5-year survival rate in HER 2 group was significantly lower than those of others subtypes(P<0.05),and the recurrence-free survival rate of 1,3 years and 5 years after surgery in patients with different subtypes were significant differences(P<0.05).The recurrence-free survival rate in HER 2 group was significantly lower than those of others subtypes(P<0.05).Cox regression analysis showed that the age(OR=1.553,95%CI:1.164~2.071),number of lymph node metastases(OR=1.305,95%CI:1.019~1.670)and molecular subtypes(OR=2.208,95%CI:1.054~2.903)were important risk factors of recur

关 键 词：分子分型 乳腺癌 复发转移风险 

分 类 号：R737.9[医药卫生—肿瘤]