妊娠中晚期乳腺癌30例临床病理特征及预后分析  

Clinicopathological characteristics and prognostic outcome of 30 patients with breast cancer during pregnancy

作　　者：马浚仁 刘亚璇 刘海燕 陆澄秋[3] 吴克瑾 MA Jun-ren;LIU Ya-xuan;LIU Hai-yan;LU Cheng-qiu;WU Ke-jin(Department of Breast,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 20001l,China;Department of Obstetrics,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 20001l,China;Department of Neonatology,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 20001l,China)

机构地区：[1]复旦大学附属妇产科医院乳腺科,上海200011 [2]复旦大学附属妇产科医院产科,上海200011 [3]复旦大学附属妇产科医院新生儿科,上海200011

出　　处：《中国实用外科杂志》2025年第2期214-219,226,共7页Chinese Journal of Practical Surgery

基　　金：上海市自然科学基金项目(No.23ZR1408400);上海市中西医协同引导项目(No.ZXXT-202301)。

摘　　要：目的 分析妊娠中晚期乳腺癌病人的临床病理学特征、预后及妊娠相关结局。方法 回顾性分析2016年1月至2023年12月复旦大学附属妇产科医院收治的30例妊娠中晚期乳腺癌病人的临床及病理学资料,包括基线资料、治疗方式、病理学资料、妊娠和子代相关结局及肿瘤预后情况。采用log-rank检验探讨无病生存期(DFS)和总生存期(OS)的影响因素。结果 所有病人的中位年龄为35(26~46)岁,确诊时中位孕周为26孕周^(+3)(范围15~36孕周),66.7%的病人存在既往生育史。美国癌症联合委员会(AJCC)分期0~Ⅱ期的病人为24例,AJCCⅢ期的病人为6例。25例病人在妊娠期接受手术治疗,24例病人在妊娠期接受化疗。2例病人选择引产,13例病人为早产,余15例为足月产。1例子代发生室间隔缺损,1例新生儿发生高胆红素血症,8例为低出生体重儿,后续发育均良好。中位随访时间为54个月,5年无病生存率和总生存率分别为90%和93.3%。AJCC分期0~Ⅱ期病人累积无病生存率(χ^(2)=13.501,P<0.01)及累积总生存率(χ^(2)=7.370,P<0.01)均高于Ⅲ期病人,经产妇的累积无病生存率(χ^(2)=5.797,P=0.016)高于初产妇,差异有统计学意义。结论 妊娠中晚期乳腺癌病人接受规范的治疗并不会造成不良的妊娠结局及子代结局,临床分期是影响妊娠期乳腺癌远期预后的危险因素。Objective To analyze the clinicopathological features,prognosis and pregnancy-related outcomes of patients with breast cancer during pregnancy.Methods Clinical and pathological data of 30 patients with breast cancer in pregnancy admitted to the Obstetrics and Gynecology Hospital of Fudan University from January 2016 to December2023 were retrospectively analyzed,including baseline data,treatment modalities,pathological data,pregnancy and offspring-related outcomes and tumor prognosis.The log-rank test was used to analyze the impacting factors of diseasefree survival (DFS) and overall survival (OS).Results The median age of the patients was 35 (26-46) years,the median gestational week at the time of diagnosis was 26~(+3) (15-36) week of pregnancy,and 66.7%of the patients had a previous reproductive history.There were 24 patients with AJCC stage 0-Ⅱand 6 patients with AJCC stageⅢ.25 patients underwent surgery,and 24 patients received chemotherapy during pregnancy.2 patients chose induced labour,13patients had preterm labour and the remaining 15 patients full-term labour.1 case of ventricular septal defect,1 case of hyperbilirubinaemia in the neonate and 8 cases of low birth weight babies were followed up with good development.The median follow-up was about 54 months,and the 5-year DFS and OS rates were 90%and 93.3%,respectively.The cumulative DFS rate (χ^(2)=13.501,P<0.01) and cumulative OS rate (χ^(2)=7.370,P<0.01) of AJCC stage 0-Ⅱpatients were higher than those of stageⅢpatients,and the cumulative DFS rate of multiparous women (χ^(2)=5.797,P=0.016) was higher than that of primiparous women,and the difference was statistically significant.Conclusions Patients with breast cancer during pregnancy who receive standardized treatment do not have adverse pregnancy outcomes or offspring outcomes,and clinical stage is an important factor influencing the longterm prognosis of patients with breast cancer during pregnancy.

关 键 词：妊娠期乳腺癌 临床病理特征 生育结局 预后 

分 类 号：R6[医药卫生—外科学]