pT1-2N1M0乳腺癌不同分子亚型的临床病理特征及对放疗的指导价值  

Clinicopathological features and guiding significance for radiotherapy of pT1-2N1M0 breast cancer with different molecular subtypes

作　　者：余思婷 王军[1] 刘磊 罗婷[2] YU Siting;WANG Jun;LIU Lei;LUO Ting(Division of Head&Neck Tumor Multimodality Treatment,Cancer Center,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Breast Disease Center,Cancer Center,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院肿瘤中心头颈肿瘤病房,成都610041 [2]四川大学华西医院肿瘤中心乳腺疾病中心,成都610041

出　　处：《华西医学》2025年第1期42-47,共6页West China Medical Journal

摘　　要：目的探索不同分子亚型在pT1-2N1M0乳腺癌患者中的预后差异及对术后放疗的决策作用。方法回顾性分析2008年—2018年四川大学华西医院就诊的1526例pT1-2N1M0乳腺癌患者的临床病理资料。运用χ^(2)检验分析不同分子亚型患者的基线分布差异,运用Kaplan-Meier生存分析和对数秩检验绘制生存曲线和分析比较各亚型患者的总生存(overall survival,OS)率和乳腺癌特异性生存(breast cancer-specific survival,BCSS)率,运用Cox回归模型分析Luminal分型以及根治术后放疗与否等临床病理特征与乳腺癌根治术后患者生存情况的关系。结果在1526例pT1-2N1M0乳腺癌患者中,Luminal A型共674例(44.2%),Luminal B型530例(34.7%),人表皮生长因子受体2(human epidermal growth factor receptor 2,Her-2)过表达型174例(11.4%),三阴性148例(9.7%)。Luminal A、Luminal B、Her-2过表达型和三阴性4种分子亚型患者5年OS率分别为98.6%、94.3%、95.5%和91.2%(χ^(2)=11.712,P=0.001),5年BCSS率分别为99.3%、94.6%、95.5%和92.5%(χ^(2)=18.547,P<0.001)。多因素Cox回归分析提示是否绝经[风险比=0.483,95%置信区间(0.253,0.923),P=0.028]以及是否内分泌治疗[风险比=2.021,95%置信区间(1.012,4.034),P=0.046]是影响pT1-2N1M0乳腺癌患者术后5年OS率的预后因素,尚不能认为Luminal分型和术后放疗是影响该部分患者术后5年OS率的预后因素(P>0.05)。结论在pT1-2N1M0乳腺癌患者中,三阴性患者5年OS率及5年BCSS率最低,Luminal分型、术后放疗与否与患者术后生存情况的关系,今后还需进一步研究。Objective To investigate the prognostic differences and decision-making role in postoperative radiotherapy of four molecular subtypes in pT1-2N1M0 stage breast cancer.Methods The clinicopathological data of 1526 patients with pT1-2N1M0 breast cancer treated at West China Hospital of Sichuan University between 2008 and 2018 were retrospectively analyzed.χ^(2)test was used to compare the clinicopathological features among patients with different molecular subtypes.Kaplan-Meier survival analysis and log-rank test were used to draw the survival curves and compare the overall survival(OS)and breast cancer-specific survival(BCSS)among patients with different molecular subtypes.Cox regression model was used to determine the influencing factors of OS of patients after radical mastectomy.Results Among the 1526 patients with pT1-2N1M0 breast cancer,there were 674 cases(44.2%)of Luminal A subtype,530 cases(34.7%)of Luminal B subtype,174 cases(11.4%)of human epidermal growth factor receptor 2(Her-2)overexpression subtype,and 148 cases(9.7%)of triple-negative subtype.The 5-year OS rates of Luminal A,Luminal B,Her-2 overexpression and triple negative patients were 98.6%,94.3%,95.5%and 91.2%,respectively(χ^(2)=11.712,P=0.001),and the 5-year BCSS rates were 99.3%,94.6%,95.5%and 92.5%,respectively(χ^(2)=18.547,P<0.001).Multiple Cox regression analysis showed that menstrual status[hazard ratio(HR)=0.483,95%confidence interval(CI)(0.253,0.923),P=0.028]and whether endocrine therapy[HR=2.021,95%CI(1.012,4.034),P=0.046]were prognostic factors for the 5-year OS rate of breast cancer patients after radical mastectomy(P<0.05).However,it failed to reveal that Luminal subtypes and postoperative radiotherapy were prognostic factors for the 5-year OS rate(P>0.05).Conclusions In pT1-2N1M0 breast cancer patients,the 5-year OS rate and 5-year BCSS rate in triple-negative patients are the lowest.The relationship between Luminal classification,postoperative radiotherapy and survival in patients after radical mastectomy needs further study in t

关 键 词：乳腺癌 Luminal分型 临床病理特征 生存分析 放射治疗 

分 类 号：R737.9[医药卫生—肿瘤]