腋窝淋巴结阳性Luminal A型乳腺癌患者新辅助与辅助化疗的预后及影响因素分析  

Prognosis of node-postive Iuminal A breast cancer patients with neoadjuvant and adjuvant chemotherapy and influencing factors

作　　者：施杰 李云涛[2] 高海燕 Shi Jie;Li Yuntao;Gao Haiyan(Department of Breast Surgery,Changzhou Cancer Hospital,Changzhou 213000,China;Breast Center,Fourth Hospital of Hebei Medical University,Shijiazhuang 050035,China)

机构地区：[1]江苏省常州市肿瘤医院乳腺外科,213000 [2]河北医科大学第四医院乳腺中心,石家庄050035

出　　处：《中华乳腺病杂志（电子版）》2023年第6期353-361,共9页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：常州市卫健委重大科技资助项目(ZD202225)。

摘　　要：目的:比较腋窝淋巴结阳性Luminal A型乳腺癌患者接受新辅助化疗和辅助化疗的预后差异。方法:回顾性分析美国国立癌症研究所监测、流行病学和最终结果(SEER)数据库(8.4.0.1)数据库中2010年1月1日至2012年12月31日登记的具有完整随访资料的13447例腋窝淋巴结阳性Luminal A型乳腺癌患者资料,其中新辅助化疗组(NAC)1534例,辅助化疗组(AC)11913例。采用1∶1近邻匹配法行倾向评分匹配法(PSM)平衡混杂因素,共匹配到2974例腋窝淋巴结阳性Luminal A型乳腺癌患者,其中NAC组和AC组各1487例。采用Kaplan-Meier法绘制生存曲线,Log-rank检验比较生存曲线。采用Cox比例风险回归模型进行预后影响因素分析。结果:PSM前2组患者在诊断年龄、肿瘤分期、T分期、N分期、组织学分级、种族、婚姻状况和病理类型方面的差异均具有统计学意义(Z=-8.877、-19.168、-28.034、-5.807、-9.575、χ^(2)=18.205、14.460、4.600,P均<0.050),PSM后NAC组和AC组患者的临床病理特征比较,差异均无统计学意义(P均>0.050)。NAC组和AC组的5年OS率分别为78.9%和86.5%,生存分析显示AC组患者预后优于NAC组患者(χ^(2)=34.575,P<0.001)。亚组分析显示2组患者中N分期越晚,预后越差(NAC组:χ^(2)=96.422,P<0.001;AC组:χ^(2)=47.205,P<0.001)。不同N分期组中AC组预后均优于NAC组患者(N1期:χ^(2)=11.585,P=0.001;N2期:χ^(2)=13.060,P<0.001;N3期:χ^(2)=12.245,P<0.001)。在N2期中接受放射治疗的患者预后优于未接受放射治疗的患者(χ^(2)=12.426,P<0.001)。多因素Cox比例风险回归模型分析显示相比新辅助化疗,辅助化疗能够改善患者预后(HR=0.613,95%CI:0.523~0.719,P<0.001),同时诊断年龄、种族、T分期、N分期、组织学分级均是患者的独立预后因素(>60岁比<45岁:HR=1.438,95%CI:1.158~1.785,P=0.001;黑种人比白种人:HR=1.323,95%CI:1.076~1.627,P=0.008;其他种族比白种人:HR=0.474,95%CI:0.339~0.664,P<0.001;T1比T0:HR=0.111,95%CI:0.034~0.360,PObjective To compare the prognosis between neoadjuvant chemotherapy(NAC)and adjuvant chemotherapy(AC)in patients with node-positive luminal A breast cancer.Methods The clinical data of 13447 node-positive luminal A breast cancer patients with complete follow-up results in the Surveillance,Epidemiology,and Results(SEER)database(8.4.0.1)from January 1,2010 to December 31,2012 were retrospectively analyzed,including 1534 patients in the NAC group and 11913 patients in the AC group.A total of 2974 patients with node-positive luminal A breast cancer were obtained by the propensity score matching(1:1 nearest neighbor matching)to balance confounding factors,including 1487 patients in the NAC group and 1487 patients in the AC group.The Kaplan-Meier method was used to draw survival curves,and the log-rank test was used for comparison.The Cox proportional risk regression model was used to analyze the prognostic factors.Results There were significant differences in age at diagnosis,tumor stage,T stage,N stage,histological grade,race,marital status and pathological type between two groups before PSM(Z=-8.877,-19.168,-28.034,-5.807,-9.575,χ^(2)==18.205,14.460,4.600;all P<0.050),while no significant dfference was found in clinicopathological characteristics between the NAC group and the AC group after PSM(all P>0.050).The 5-year OS was 78.9%and 86.5%in the NAC and AC group,respectively.Survival analysis showed that the patients in the AC group had a significantly better prognosis compared with the NAC group(χ^(2)==34.575,P<0.001).Subgroup analysis showed that the later the N stage,the poorer the prognosis in both groups(NAC group:χ^(2)==96.422,P<0.001;AC group:χ^(2)==47.205,P<0.001).In the patients with different N stage,the prognosis of the AC group was significantly better than that of the NAC group(Ni:χ^(2)==11.585,P=0.001;N2:χ^(2)==13.060,P<0.001;N3:X?=12.245,P<0.001).In the patients at N,stage,the patients who received radiation therapy had a significantly better prognosis than those who did not receive radiation th

关 键 词：乳腺肿瘤 辅助化疗 预后 

分 类 号：R737.9[医药卫生—肿瘤]