三阴性乳腺癌的临床病理特征及预后因素分析

目的分析三阴性乳腺癌(TNBC)与非三阴性乳腺癌(non-TNBC)的临床病理学特征及生存差异,探讨影响TNBC患者预后的因素。方法回顾性分析2010年1月至2013年12月就诊于吉林大学第一医院肿瘤中心、可手术切除的早期乳腺癌800例患者的临床病理特征、治疗方案、局部复发或远处转移及生存情况等资料。结果130(16.25%)例为TNBC,670例为non-TNBC。TNBC与non-TNBC患者在发病年龄、乳腺癌家族史、肿瘤长径、腋窝淋巴结转移、组织学分级、病理类型、Ki-67指数、临床分期方面差异有统计学意义(P均<0.05),在月经状态、手术方式、放疗方面差异无统计学意义(P均>0.05)。TNBC患者3年(70.70%)、5年无病生存(DFS)率(62.30%)及5年总生存(OS)率(83.84%)明显低于non-TNBC患者(87.76%、78.06%、95.22%,P均<0.001)。单因素分析显示影响TNBC患者DFS期和OS期的因素有肿瘤长经、腋窝淋巴结转移、临床分期、脉管或神经浸润。多因素分析显示肿瘤长径、月经状态及临床分期是TNBC患者DFS期的独立危险因素,而肿瘤长径是其OS期的唯一独立危险因素。结论与non-TNBC相比,TNBC具有发病年龄早、家族聚集现象、肿块长径大、早期易出现腋窝淋巴结转移、组织学分级高、临床分期偏晚、Ki-67指数高、局部复发或远处转移率高,远期预后较差等特点。尽早明确TNBC诊断及病理特征,给予个体化综合治疗及后续的规律复查对判断及改善预后、提高生活质量、延长生存期具有重要的临床意义。

Clinicopathological features and prognostic factors of triple negative breast cancer

ObjectiveTo analyze the clinicopathological characteristics and survival differences between patients with triple negative breast cancer (TNBC) and those with non-TNBC, and to explore the factors influencing the prognosis of TNBC patients. MethodsThe clinical and pathological characteristics, treatment plan, local recurrence or distant metastasis, and survival of 800 patients with early breast cancer who were treated at the Tumor Center of the First Hospital of Jilin University from January 2010 to December 2013 were analyzed retrospectively. ResultsA total of 130 (16.25%) patients were confirmed with TNBC and 670 with non-TNBC by immunohistochemistry. Compared with non-TNBC, TNBC had significantly different age of onset, family history of breast cancer, tumor length, axillary lymph node status, histological grade, pathological type, Ki-67 index, and clinical stage (P<0.05), though no significant differences were noted in menstrual status, operation mode, or radiotherapy (P>0.05). The local recurrence and metastasis rate of TNBC patients was significantly higher than that of non-TNBC patients. The 3-year and 5-year disease free survival (DFS) rates and 5-year overall survival (OS) rate of TNBC patients were significantly lower than those of non-TNBC patients (P<0.001), but the 3-year OS rates of the two groups had no statistical difference (P>0.05). Univariate analysis showed that the factors influencing DFS and OS in TNBC patients were tumor length, axillary lymph node status, clinical stage, and vascular or neural infiltration. Multivariate analysis showed that tumor length, menstrual status, and clinical stage were independent risk factors for DFS in TNBC patients, while tumor length and diameter were independent risk factors for OS. ConclusionCompared with non-TNBC, TNBC has the characteristics of early onset age, family aggregation, large mass length, easy axillary lymph node metastasis in early stage, high histological grade, late clinical stage, high Ki-67 index, high local recurrence or distant metastasis rate, and poor long-term prognosis. Therefore, it is of great clinical significance to make a diagnosis and obtain the pathological features of TNBC as early as possible, in order to give individualized comprehensive treatment and regular follow-up to improve the prognosis and quality of life and prolong the survival period.