T1期乳腺癌的临床病理特征及预后危险因素分析  

Analysis of clinicopathologic characteristics and prognostic risk factors in T1 stage breast cancer

作　　者：张倩[1,2,3] 彭帅 王晓敏 王潇潇 张航豪 廖立秋[1,2,3] ZHANG Qian;PENG Shuai;WANG Xiaomin;WANG Xiaoxiao;ZHANG Hanghao;LIAO Liqiu(Department of Breast Surgery,Xiangya Hospital,Central South University,Changsha 410008,China;Breast Cancer Clinical Research Center,Xiangya Hospital,Central South University,Changsha 410008,China;National Clinical Research Center for Geriatric Disorders,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院乳腺外科,湖南长沙410008 [2]中南大学湘雅医院乳腺癌临床研究中心,湖南长沙410008 [3]中南大学湘雅医院国家老年疾病临床研究中心,湖南长沙410008

出　　处：《中国普通外科杂志》2023年第5期761-770,共10页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(81974420);湖南省自然科学基金资助项目(2021JJ30041)。

摘　　要：背景与目的:T1期乳腺癌患者总体生存预后良好,但仍有少部分患者具有高度侵袭性,早期容易出现复发转移与死亡等不良生存结局,预后较差。本研究探讨影响T1期乳腺癌的临床病理特征及预后的危险因素,旨在早期识别高风险的T1期乳腺癌患者,为临床决策提供参考。方法:回顾性分析中南大学湘雅医院2011年1月—2015年12月经手术治疗的1250例T1~T3期原发性浸润性乳腺癌患者资料,分析T1期与非T1期患者的临床病理学特征差异,单因素及多因素Cox风险模型分析影响T1期乳腺癌患者复发转移及死亡的危险因素,Kaplan‑Meier法分析不同危险因素下T1期乳腺癌患者总生存(OS)和无病生存(DFS)的差异,Log‑rank检验比较组间生存曲线差异。结果:1250例原发性浸润性乳腺癌患者中,T1期261例(20.88%),非T1期(T2和T3期)989例(79.12%)。与非T1期比较,T1期患者BMI值低、腋窝淋巴结转移数目少、不利生物学特性少、生存预后好(均P<0.05)。T1期患者随访期间共15例死亡,40例出现复发转移。中位OS时间为94(5~132)个月,2、5、10年OS率分别为97%,95%和94%。中位DFS时间为92(4~138)个月,2、5、10年DFS率分别为95%,88%和82%。多因素Cox风险模型结果提示,淋巴结转移(HR=4.904,95%CI=1.588~15.144,P=0.006)和不利生物学特性(HR=4.241,95%CI=1.433~12.552,P=0.009)是T1期患者OS的独立危险因素。淋巴结转移(HR=3.118,95%CI=1.553~6.262,P=0.001),不利生物学特性(HR=2.295,95%CI=1.034~5.093,P=0.041)和Ki‑67>14%(HR=2.258,95%CI=1.079~4.723,P=0.031)是T1期患者DFS的独立危险因素。生存分析显示,在淋巴结转移阳性的T1期患者中,伴有利生物学特性患者的OS及DFS与淋巴结转移阴性的患者无明显差异(均P>0.05),而伴不利生物学特性的患者OS及DFS最差(均P<0.05)。结论:T1期浸润性乳腺癌患者总体预后较好,但腋窝淋巴结转移及不利生物学特性是T1期乳腺癌患者早期复发转移及死亡的危险因�Background and Aims:T1 stage breast cancer patients have an overall favorable prognosis,but there is still a small subset of patients who exhibit high invasiveness and are prone to adverse outcomes such as recurrence,metastasis,and death,leading to a poorer prognosis.This study was conducted to investigate the clinicopathologic characteristics that influence T1 stage breast cancer and determine the risk factors associated with prognosis,for early identification of high-risk T1 stage breast cancer patients and providing reference for clinical decision-making.Methods:The data of 1250 patients with primary invasive breast cancer at stages T1 to T3 who underwent surgical treatment at Xiangya Hospital,Central South University,from January 2011 to December 2015 were retrospectively analyzed.The differences in clinicopathologic characteristics between T1 and non-T1 stage patients were determined.Univariate and multivariate Cox regression models were used to analyze the risk factors affecting recurrence,metastasis,and death in T1 stage breast cancer patients.The Kaplan-Meier method was employed to assess the differences in overall survival(OS)and disease-free survival(DFS)among T1 stage breast cancer patients with different risk factors,and the Log-rank test was used to compare the survival curves between groups.Results:Among the 1250 patients with primary invasive breast cancer,there were 261 cases(20.88%)at stage T1 and 989 cases(79.12%)at non-T1 stage(T2 and T3).Compared to non-T1 stage patients,T1 stage patients had lower BMI value,fewer axillary lymph node metastases,fewer unfavorable biological characteristics,and better survival prognosis(all P<0.05).During the follow-up period,there were 15 deaths and 40 cases of recurrence and metastasis among T1 stage patients.The median OS was 94(5-132)months,with 2-,5-,and 10-year OS rates of 97%,95%,and 94%,respectively.The DFS was 92(4-138)months,with 2-,5-,and 10-year DFS rates of 95%,88%,and 82%,respectively.The results of the multivariate Cox regression model indicated t

关 键 词：乳腺肿瘤 危险因素 淋巴转移 预后 

分 类 号：R737.9[医药卫生—肿瘤]