763例三阴性乳腺癌临床病理特征及复发、转移影响因素分析

目的 通过对三阴性乳腺癌(Triple-negative breast cancer,TNBC)临床病理特征的分析,探讨影响三阴性乳腺癌患者的复发、转移因素和转移淋巴结与原发灶位置之间关系。方法 收集哈医大附属肿瘤医院2008年12月—2012年12月资料完整的763例三阴性乳腺癌患者的临床资料进行回顾性分析。结果 三阴性乳腺癌平均发病年龄49岁,早期患者占84.7%,淋巴结阳性患者复发、转移率均明显高于淋巴结阴性患者,并随淋巴结数目的增多而增加(P＜0.001),对于淋巴结阴性患者,原发灶位于内象限时复发、转移率最高(9.8%和13.7%)(P＜0.05)。单因素分析显示淋巴结状态、手术方式、放疗剂量是影响三阴性乳腺癌患者复发、转移的因素(P＜0.05)。多因素分析显示临床分期、淋巴结状态是影响三阴性乳腺癌复发的独立危险因素,临床分期和和手术方式是影响三阴性乳腺癌转移的独立危险因素(P＜0.05)。结论 (1)三阴性乳腺癌患者早期病例所占比例高,主要病理类型为浸润性导管癌,ki67阳性表达率高;(2)淋巴结阳性患者预后与转移淋巴结数目相关,和原发灶位置无关,对于淋巴结阴性患者,原发灶位于内象限复发、转移率最高;(3)TNBC患者复发率随BMI值的增加而增加,但对于肥胖患者,复发率反而下降;(4)淋巴结状态、临床分期、手术方式、放疗剂量均影响三阴性乳腺癌患者的复发、转移;(5)临床分期、淋巴结状态是影响三阴性乳腺癌复发的独立危险因素,临床分期和和手术方式是影响三阴性乳腺癌转移的独立危险因素。

Analysis of clinicopathological features,recurrence and metastasis in 763 triple-negative breast cancer

Objective Through the analysis of the clinicopathological features of triple-negative breast cancer(TNBC),the relationship between recurrence,metastasis,the location of metastatic lymph nodes and primary lesions in breast cancer patients with TNBC was investigated.Methods The clinical data of 763 patients with TNBC from December 2008 to December 2012 in our hospital were retrospectively analyzed.Results The onset average age of TNBC breast cancer was 49 years old,and 84.7% of patients with early stage.The recurrence and metastasis rates of lymph node-positive patients were significantly higher than those of lymph node-negative patients,and increased the number of lymph nodes(P＜0.001).In the patient with negative for lymph nodes,the primary tumor recurred in the inner quadrant and the metastasis rates were the highest(9.8% and 13.7%)(P＜0.05).Univariate analysis showed that lymph node status,surgical procedure,and radiation dose were factors influencing recurrence and metastasis in patients with TNBC(P＜0.05).Multivariate analysis showed that clinical stage and lymph node status were independent risk factors for recurrence of TNBC.Clinical stage and surgical approach were independent risk factors for the metastasis of TNBC(P＜0.05).Conclusion (1)The proportion of patients with TNBC at early stage is high.The main pathological type is invasive ductal carcinoma,and the positive expression rate of ki67 is high.(2)The prognosis of patients with positive lymph nodes was related to the number of metastatic lymph nodes,and there was not significant correlated with the location of primary tumor.For patients with negative lymph nodes,the primary tumor was located in the inner quadrant with the highest recurrence and metastasis rates.(3)The recurrence rate of TNBC patients increased with the increase of BMI,but for obese patients,the recurrence rate decreased.(4)Lymph node status,clinical stage,surgical procedure,and radiotherapy dose all affect recurrence and metastasis of patients with TNBC.(5)Clinical stage and lymph node status are independent risk factors for the recurrence of TNBC.Clinical stage and surgical approach are independent risk factors for the metastasis of TNBC.