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中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (03) : 268 -272. doi: 10.3877/cma.j.issn.1674-3946.2020.03.016

所属专题: 文献

论著

大连市不同型别乳腺癌患者的临床病理特征与生存状况研究
李传书1, 葛述科1,(), 高伟1, 孙嘉忆1, 陈波2   
  1. 1. 116033 辽宁省大连市中心医院
    2. 110001 沈阳,中国医科大学附属第一医院消化内科
  • 收稿日期:2019-08-29 出版日期:2020-06-26
  • 通信作者: 葛述科

Clinical investigation of clinicopathological characteristics and survival status of female patients with different types of breast cancer in Da lian City

Chuanshu Li1, Shuke Ge1,(), Wei Gao1, Jiayi Sun1, Bo Chen2   

  1. 1. Dalian Central Hospital, Dalian, Liaoning 116033, China
    2. Department of Gastroenterology, the First Affiliated Hospital of China Medical University, Liaoning 110001, China
  • Received:2019-08-29 Published:2020-06-26
  • Corresponding author: Shuke Ge
  • About author:
    Corresponding author: Ge Shuke, Email:
  • Supported by:
    Science and technology plan project of Science and Technology Department of Liaoning Province(2013225049)
引用本文:

李传书, 葛述科, 高伟, 孙嘉忆, 陈波. 大连市不同型别乳腺癌患者的临床病理特征与生存状况研究[J]. 中华普外科手术学杂志(电子版), 2020, 14(03): 268-272.

Chuanshu Li, Shuke Ge, Wei Gao, Jiayi Sun, Bo Chen. Clinical investigation of clinicopathological characteristics and survival status of female patients with different types of breast cancer in Da lian City[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(03): 268-272.

目的

分析大连市不同型别乳腺癌妇女的临床病理特征与生存状况。

方法

选取2014年10月至2016年10月期间行外科手术的226例原发单侧乳腺癌患者为研究对象,根据分子分型分为Luminal A型、Luminal B型、HER-2型、三阴型,比较四种分型的临床病理资料和随访结果并比较之。采用SPSS19.0统计学软件进行数据处理。观测资料主要为计数资料,以例数及率描述,单因素分析采用χ2检验。生存资料建立KaplanMeier乘积限模型,生存率比较应用Logrank检验。以P<0.05视为有统计学意义。

结果

LuminalA型、Luminal B型、HER-2型、三阴型分别占28.8%、34.1%、14.6%、22.6%。不同分子分型患者的肿瘤最大径、淋巴结转移、组织学分级、术后内分泌治疗等比较,差异有统计学意义(P<0.05)。四组不同分子分型患者的3年无病生存率、总生存率(OS)比较,经Logrank检验,仅Luminal A型的PFS生存率明显高于三阴型(P<0.05),其他差异无统计学意义(P>0.05)。

结论

大连市乳腺癌妇女患者以Luminal B型最常见,LuminalA型组织学分级较低,预后较好;HER-2型肿瘤较大,但淋巴结转移率较低;三阴型容易发生淋巴结转移,预后较差。内分泌治疗对Luminal型效果较好,靶向药物化疗适用于HER-2型和三阴型患者,放疗适用于晚期乳腺癌患者,尤其是三阴型。

Objective

To analysis the clinicopathological characteristics and survival status of female patients with different types of breast cancer in Da lian City.

Methods

A retrospective analysis was performed in 226 patients with primary unilateral breast cancer, who underwent surgery from October 2014 to October 2016. According to the molecular classification, they were divided into four types, including Luminal A, Luminal B, HER-2, and Triple negative. The clinicopathological data and follow-up results of patients with different types were analyzed. Statistical analysis were performed by using SPSS19.0 software. The observational data were mainly count data, and were described as cases and rate, and were examined by using the single factor analysis of χ2 test. Survival data were analyzed by using Kaplan-Meier method. Logrank test was used to compare survival rates. A value of P<0.05 was considered as statistically significant difference.

Results

Luminal A type, Luminal B type, HER-2 type, and triple negative ty pe accounted for 28.8%, 34.1%, 14.6%, and 22.6%, respectively. There were significant differences among patients with different molecular types, in terms of tumor size, lymph node metastasis, histological grade, and postoperative endocrine therapy (P<0.05) . Three-year progression-free survival (PFS), overall survival (OS) were compared among four groups of patients with different molecular types. Logrank test showed that the PFS in Luminal A group was significantly higher than that in triple negative group (P<0.05), however there no significant differences between other groups (P>0.05).

Conclusions

Luminal B is the most common type of breast cancer in female patients in Dalian city. There are lower histological grade and better prognosis in Luminal A type. There are larger tumors and lower rate of lymph node metastasis in HER-2 type. Triple negative type is prone to lymph node metastases, and the prognosis is poor. Endocrine therapy has a better effect on Luminal type, targeted drug chemotherapy is suitable for HER-2 or Triple negative type patients, and radiotherapy is suitable for advanced breast cancer patients, especially for triple negative type.

表1 226例原发单侧乳腺癌患者新辅助化疗后病理完全应答的单因素分析 [例(%)]
临床特征 Luminal A型(n=65) Luminal B型(n=77) HER-2型(n=33) 三阴型(n=51) χ2 P
起病年龄(岁) ? ? ? ? ? ?
? ≥50 21(32.3) 30(39.0) 15(45.4) 29(56.9) 7.583 0.055
? <50 44(67.7) 47(61.0) 18(54.6) 22(43.1)
BMI(kg/m2) ? ? ? ? ? ?
? ≥24.0 32(49.2) 34(44.2) 15(45.4) 25(49.0) 0.494 0.920
? <24.0 33(50.8) 43(55.8) 18(54.6) 26(51.0)
月经状态 ? ? ? ? ? ?
? 绝经前 42(64.6) 43(55.9) 13(39.4) 24(47.1) 6.877 0.076
? 绝经后 23(35.4) 34(44.2) 20(60.6) 27(52.9)
乳腺癌家族史 ? ? ? ? ? ?
? 5(7.7) 15(19.5) 4(12.1) 3(5.9) 7.057 0.070
? 60(92.3) 62(80.5) 29(87.9) 48(94.1)
病理类型 ? ? ? ? ? ?
? 导管癌 61(93.9) 72(93.5) 32(97.0) 47(92.2) 0.819 0.845
? 其他 4(6.2) 5(6.5) 1(3.0) 4(7.8)
肿瘤分期 ? ? ? ? ? ?
? Ⅰ~Ⅱ期 57(87.7) 66(85.7) 27(81.8) 41(80.4) 1.432 0.698
? Ⅲ~Ⅳ期 8(12.3) 11(14.3) 6(18.2) 10(19.6)
肿瘤最大径(cm) ? ? ? ? ? ?
? ≥2 19(29.2) 34(44.2) 24(72.7) 16(31.4) 19.702 <0.001
? <2 46(70.8) 43(55.8) 9(27.3) 35(68.6)
组织学分级 ? ? ? ? ? ?
? Ⅰ~Ⅱ级 53(81.5) 39(50.7) 15(45.5) 29(56.9) 18.512 <0.001
? Ⅲ级 12(18.5) 38(49.4) 18(54.6) 22(43.1)
淋巴结转移数目 ? ? ? ? ? ?
? 30(46.2) 38(49.4) 11(33.3) 35(68.6) 11.126 0.011
? 35(53.9) 39(50.7) 22(66.7) 16(31.4)
手术方式 ? ? ? ? ? ?
? 乳腺癌改良根治术 58(89.2) 71(92.2) 31(93.9) 46(90.2) 0.780 0.854
? 其他 7(10.8) 6(7.8) 2(6.1) 5(9.8)
术后放疗 ? ? ? ? ? ?
? 20(30.8) 24(31.2) 12(36.4) 15(29.4) 0.485 0.922
? 45(69.2) 53(68.8) 21(63.6) 36(70.6)
术后化疗 ? ? ? ? ? ?
? 58(89.2) 72(93.5) 31(93.9) 48(94.1) 1.401 0.705
? 7(10.8) 5(6.5) 2(6.1) 3(5.9)
术后内分泌治疗 ? ? ? ? ? ?
? 42(64.6) 46(59.7) 6(18.2) 12(23.5) 35.402 <0.001
? 23(35.4) 31(40.3) 27(81.8) 39(76.5)
图1 226例原发单侧乳腺癌患者新辅助化疗后各型组的PFS (无复发或转移)和OS (总生存) Kaplan-Meier生存曲线
表2 226例原发单侧乳腺癌患者新辅助化疗后病理完全应答的多因素分析
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