305例三阴乳腺癌患者的临床特征及预后因素分析

背景与目的:三阴乳腺癌(triple-negative breast cancer)指雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)和HER2/neu均无表达的乳腺癌,被认为是一种独立的临床病理类型,以侵袭性强、预后较差为主要特征的乳腺癌。本研究目的在于分析三阴乳腺癌的临床特征和影响预后的因素。方法:收集2000年1月至2004年12月中山大学肿瘤防治中心收治的经病理组织学证实、有完整随访资料的1280例可手术乳腺癌患者的临床资料,经病理学检查证实ER、PR和HER2/neu均为阴性的三阴乳腺癌305例(23.8%)。回顾性分析三阴乳腺癌患者的临床特征、复发及生存情况。结果:本组乳腺癌患者中有23.8%(305/1280)是三阴乳腺癌,多见于年轻患者,诊断时肿块较大、局部淋巴结阳性者较多,有乳腺癌家族史的患者较多。截止至2007年6月,三阴乳腺癌组患者中位随访时间为52个月(28～89个月),有234例患者出现复发及转移,94例已死亡。三阴乳腺癌组局部复发率与非三阴乳腺癌患者相比无显著性差异;但三阴乳腺癌患者远处转移发生率显著增高,主要表现肺转移(HR=4.41,P<0.001)和肝转移(HR=2.13,P=0.006)发生率高。生存分析显示,三阴乳腺癌患者的5年无病生存率和总生存率分别为73.7%和88.5%,均显著低于非三阴乳腺癌患者(80.8%和92.8%,P=0.025,P=0.010)。多因素分析显示,肿块大小和淋巴结状况是影响三阴乳腺癌预后的两个主要因素。结论:三阴乳腺癌在乳腺癌中占有约1/4的比例。这些患者往往年轻、有乳腺癌家族史、肿块较大、淋巴结阳性多。三阴乳腺癌容易出现肺转移和肝转移,这可能是导致三阴乳腺癌预后较差的重要原因。

Clinical characteristics and prognosis of triple-negative breast cancer: a report of 305 cases

BACKGROUND & OBJECTIVE: Triple-negative breast cancer is defined by a lack of expression of estrogen receptor, progesterone receptor, and HER2/neu, and considered to be a clinicopathologic entity with aggressive behaviors and poor prognosis. No satisfactory treatment is available. This study was to analyze the clinical characteristics and prognostic factors of the patients with triple-negative breast cancer. METHODS: Clinical data of 1,280 patients with histopathologically confirmed resectable breast cancer, treated at Cancer Center of Sun Yat-sen University from Jan. 2000 to Dec. 2004, were analyzed. Of the 1,280 patients, 305 (23.8%) were confirmed to be triple-negative breast cancer. The clinical characteristics, recurrence and survival of the patients were summarized. RESULTS: Triple-negative breast cancer was commonly seen in young patients, with large masses, a high proportion of lymph node metastasis and familial history of breast cancer at diagnosis. By Jun. 2007, the median time of follow-up was 52 months (range, 28-89 months). Of the 1,280 patients, 234 had local recurrence and metastasis, and 94 died. There was no significant difference in local recurrence between triple-negative and non-triple-negative breast cancer patients. However, the occurrence rates of lung metastasis (HR= 4.41, P<0.001) and liver metastasis (HR=2.13, P=0.006) were significantly higher in triple-negative breast cancer patients than in non-triple-negative breast cancer patients. The 5-year disease-free and overall survival rates were significantly lower in triple-negative breast cancer patients than in non-triple-negative breast cancer patients (73.7% vs. 80.8%, P=0.025; 88.5% vs. 92.8%,P=0.010). Multivariate Cox regression analysis showed that tumor size and lymph node state were prognostic factors of triple-negative breast cancer patients. CONCLUSIONS: Nearly one fourth of breast cancer patients in China are triple-negative breast cancer patients. These patients are usually young, with large masses, lymph node metastasis, and family history of breast cancer. Lung metastasis and liver metastasis may be the main reason of poor prognosis of triple-negative breast cancer.