腋窝淋巴结状态对不同类型浸润性乳腺癌预后的影响  

Effect of axillary lymph node status on prognosis of different types of invasive breast cancer

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

机构地区：[1]北京大学肿瘤医院,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,北京100142

出　　处：《中华医学杂志》2021年第30期2382-2386,共5页National Medical Journal of China

基　　金：北京市优秀人才培养资助青年骨干个人项目(2018000021469G261);北京市属医院科研培育项目(PX2018041)。

摘　　要：目的探讨腋窝淋巴结状况对不同类型浸润性乳腺癌预后的影响。方法回顾性分析2000年1月至2011年7月在北京大学肿瘤医院乳腺癌预防治疗中心确诊的不同分子亚型浸润性乳腺癌患者的治疗后长期生存情况,并分析淋巴结状态对其预后的影响。结果研究纳入4269例乳腺癌分子亚型资料齐全[年龄(50.8±11.2)岁]和3824例腋窝淋巴结状态齐全[年龄(50.5±10.9)岁]的乳腺癌患者,均为女性,其中分子亚型和淋巴结状态信息均齐全的共3135例。激素受体(HR)^(+)/人表皮生长因子受体-2(HER2)^(-)、HR^(-)/HER2^(-)型及HER2^(+)患者的10年无事件生存(EFS)率分别为82.2%、79.0%与76.8%;10年的总生存(OS)率分别为88.1%、83.1%与84.4%;生存曲线的差异均有统计学意义(均P<0.001)。淋巴结阳性和阴性患者的10年EFS率分别为68.8%与88.2%;10年的OS率分别为76.7%与92.5%;生存曲线差异也均有统计学意义(P<0.001)。淋巴结阴性亚组3亚型EFS与OS率十分接近,差异均无统计学意义(均P>0.05);淋巴结阳性亚组3亚型EFS与OS率差异均有统计学意义(均P<0.05)。未发现腋窝淋巴结状态对乳腺癌分子亚型与EFS、无远处转移生存(DDFS)、OS率的关联存在修饰作用(均P_(交互)>0.1)。结论不同分子亚型乳腺癌的预后不同,相比分子分型,淋巴结状态可能是更重要的预后影响因素。Objective To investigate the effect of axillary lymph node status on the prognosis of different types of invasive breast cancer.Methods Patients with invasive breast cancer of different molecular subtypes diagnosed in the breast cancer prevention and treatment center of Beijing Cancer Hospital from January 2000 to July 2011 were collected as a historical cohort,and the influence of lymph node status on the prognosis of different types of breast cancer was analyzed.Results A total of 4269 female breast cancer patients with molecular subtypes[aged(50.8±11.2)years]information and 3824 female breast cancer patients with complete axillary lymph node status information[aged(50.5±10.9)years]were included in the study,including 3135 cases with both molecular subtypes and lymph node status information.The 10-year event free survival(EFS)rates of hormone receptor(HR)^(+)/human epidermal growth factor receptor-2(HER2)^(-),HR^(-)/HER2^(-)and HER2^(+) were 82.2%,79.0%and 76.8%,respectively;the 10-year overall survival(OS)rates were 88.1%,83.1%and 84.4%,respectively,and the differences of 3 molecular subtypes in EFS and OS were statistically significant(both P<0.001).The 10-year EFS rate of lymph node positive and negative patients was 68.8%and 88.2%,respectively;the 10-year OS rate was 76.7%and 92.5%,respectively,and the differences of lymph node status in EFS and OS were statistically significant(both P<0.001).In lymph node negative subgroup,3 subtypes showed similar EFS and OS rate(both P>0.05);In lymph node positive subgroup,3 subtypes showed significantly different EFS and OS(both P<0.05).No modification effect was detected of lymph node status on the correlation of molecular subtypes and EFS,DDFS and OS(all P_(interactive)>0.1).Conclusions Different molecular subtypes of breast cancer have different prognosis.Compared with molecular subtype,lymph node status may be a more important prognostic factor.

关 键 词：乳腺肿瘤 分子亚型 腋窝淋巴结 预后 

分 类 号：R737.9[医药卫生—肿瘤]