356 例三阴性乳腺癌的临床特征及预后多因素分析

目的:分析三阴性与非三阴性乳腺癌患者临床病理学特征的差异，了解两组患者的生存状态，探讨三阴性乳腺癌患者的独立预后影响因素。方法:收集本院356 例三阴性乳腺癌患者的临床病理学特征、复发转移及生存情况等资料，采用SPSS13.0统计软件进行分析，频数资料组间比较采用χ2检验。临床病理指标单因素分析采用Kaplan-Meier 法，组间曲线比较用Log-Rank检验，多因素分析采用Cox 回归分析。取P<0.05为差异有统计学意义。结果:比较三阴组与非三阴组临床病理学特点，发现三阴性乳腺癌患者中年龄小于35岁者为8.43%（P=0.000），Ⅲ期患者为21.91%（P=0.022），肿瘤直径>5cm者为13.91%（P=0.000），腋窝淋巴结阳性者为56.46%（P=0.017），组织学分级Ⅲ级患者为21.35%（P=0.002）。 两组5 年无瘤生存率和累计总生存率的差异均具有统计学意义（P=0.010，P=0.003）。 单因素分析结果显示影响三阴乳腺癌患者总生存率的因素有临床分期、肿瘤大小、淋巴结状态。多因素分析结果显示淋巴结状态为三阴乳腺癌患者总生存率的独立预后因素。结论:与非三阴组相比，三阴性乳腺癌具有肿瘤体积较大，组织学分级较高，诊断时分期较晚，无病生存及总生存率均较低，较早发生转移的高危特点。明确患者年龄、病理类型、肿瘤大小、临床分期、组织学分级，特别是淋巴结状态对于判断预后有重要指导意义。 

Clinical Features and Multivariate Cox Regression Prognostic Analysis of Triple-Negative Breast Cancer:A Report of 356 Cases

Objective:To compare the clinical features and survival for patients with triple-negative (TNBC) and non-tri -ple-negative (non-TNBC) breast cancer, and analyze the prognosis of triple-negative breast cancer. Methods:The clinical data and survival status of 356 patients with TNBC treated in our hospital were collected. SPSS 13.0 software was used for statistical treatment. Chi-square test was used for the comparison of frequency data between the different groups. Ka-plan-Meier method was applied to analyze survivals. Log- Rank was used to compare curves between the different groups. Cox regression was applied for multivariate prognostic analysis. Statistical significance was considered atP<0.05. Results: Compared with non-TNBC, TNBC patients had some special features: 8.43% were below35years old ( P=0.000 ), 21.91% were of clinical stage Ⅲ(P=0.022 ), 13.91% had tumor size larger than5cm (P=0.000 ), 56.46% had positive lymph node status (P=0.017 ), and 21.35% were of histological grade Ⅲ. The 5-year disease-free and overall survival rates were signifi -cantly lower in TNBC than those in non TNBC (P=0.010 , P=0.003 ). For TNBC patients, monofactorial analysis showed clini -cal stage, tumor size and lymph node state were prognostic factors. Multivariate Cox regression analysis showed lymph node state was a prognostic factor. Conclusion:Compared with non-TNBC, TNBC correlates with younger age, larger tu-mor size, more positive axillary lymph nodes, higher histologic and pathologic grade, whose DFS and OS are lower and earlier, indicating local recurrence and distant metastasis. It is important to get the information of age, tumor type, tumor size, clinical stage and histological grade, especially the lymph nodes, to judge the prognosis.