Luminal A型早期乳腺癌化疗决策的影响因素分析

目的:分析腔内细胞(luminal)A型早期乳腺癌的临床病理特征对化疗决策的影响。方法:回顾性分析2010年11月至2013年12月我院收治的232例luminal A型早期女性乳腺癌病人的临床病理资料及治疗方法。采用χ2检验和Logistic回归分析其化疗决策的影响因素。结果:232例病人行保乳手术或乳房切除术,前哨淋巴结活检或腋清,其中72例(31.0%)接受术后辅助化疗。单因素分析显示不同的年龄组、月经状态、淋巴结转移、组织学分级、病理类型和手术方式的病人,其化疗比例表现出明显的差异,而雌激素受体和孕激素受体的表达量并未影响其化疗决策。多因素分析表明淋巴结1~3枚阳性病人的化疗比例显著高于淋巴结阴性病人(75.9%比16.1%,OR=27.302,P0.001)。绝经后病人化疗比例明显低于绝经前病人(20.1%比47.3%,OR=0.173,P=0.018)。70岁病人只有1例接受化疗,明显低于≤50岁的病人(OR=0.039,P=0.014)。在淋巴结阴性的病人中,多因素分析显示绝经后病人接受化疗的比例显著低于绝经前病人(7.5%比29.4%,OR=0.146,P=0.040)。结论:淋巴结转移、年龄和月经状态是影响luminal A型早期乳腺癌化疗决策的重要因素。70岁以上病人或淋巴结阴性的绝经后病人倾向于不接受化疗。

Influence on chemotherapy decision for luminal A early breast cancer

Objective To analyze the effect on chemotherapy decisions of luminal A early breast cancer with the clinicopathological characteristics. Methods A retrospective analysis of the clinicopathological features and treatment protocol of 232 cases with luminal A early breast cancer in our hospital from November 2010 to December 2013 was done. The factors which could affect chemotherapy were analyzed by chi-square test and Logistic regression. Results There were 232 patients with luminal A early breast cancer performed breast-conserving surgery or mastectomy with sentinel lymph node biopsy or axillary dissection. Seventy-two cases （31.0%） were treated with chemotherapy. It was shown by univariate analysis that age, menopausal status, lymph node metastasis, histological grade, pathological type and surgical type were significantly correlated with chemotherapy decision, while the expression of estrogen receptor and progesterone receptor did not affect the decisions of chemotherapy. It was shown with muhivariate analysis that the patients with 1-3 positive lymph nodes received chemotherapy was more than the patients with negative lymph node （75.9% vs 16.1%, OR=27.302, P〈0.001）. Postmenopausal patients received chemotherapy less than premenopausal patients （20.1% vs 47.3%, OR=0.173, P=0.018）. Only 1 patient 〉70 years received chemotherapy with significant OR （0.039） compared with patients ≤50 years （P=0.014）. Less patients after menopause had chemotherapy than premenopausal patients in the group of patients with lymph node negative shown by multivariate analysis （7.5% vs 29.4%, OR=0.146, P=0.040）. Conclusions Lymph node metastasis, age and menopausal status are the important factors affecting the chemotherapy decision of luminal A early breast cancer. The patients older than 70 years or postmenopausal patients with negative lymph node do not tend to re- ceive chemotherapy.