局部晚期Luminal A型乳腺癌患者的临床病理学特征及预后分析

目的比较早中期Luminal A型乳腺癌和局部晚期Luminal A型乳腺癌患者的临床病理学特征,并进一步探讨局部晚期Luminal A型乳腺癌无瘤生存的影响因素。方法回顾性收集2010年1月至2012年12月期间在笔者所在医院完成诊断、治疗和随访的295例Luminal A型乳腺癌患者的临床资料,按TNM分期分为早中期乳腺癌227例及局部晚期乳腺癌68例。采用成组χ2检验或秩和检验比较2组患者的临床病理学特征,并采用log-rank检验及Cox比例风险回归模型探索局部晚期Luminal A型乳腺癌患者5年无瘤生存的影响因素。结果局部晚期Luminal A型乳腺癌患者的T分期和N分期较早中期Luminal A型乳腺癌患者更晚,肿瘤分级更高(P<0.05)。全组患者的5年DFS率为87.8%(259/295)。局部晚期Luminal A型乳腺癌患者的5年无瘤生存率低于早中期Luminal A型乳腺癌患者(76.5%比91.2%,P=0.001)。局部晚期Luminal A型乳腺癌患者的治疗方案包括:新辅助化疗+手术+放疗+内分泌治疗、新辅助化疗+手术+内分泌治疗、手术+化疗+放疗+内分泌治疗、手术+化疗+内分泌治疗和手术+放疗+内分泌治疗。单因素分析结果显示:T分期(χ2=8.248,P=0.040)、N分期(χ2=9.470,P=0.024)、脉管侵犯(χ2=4.211,P=0.031)及肿瘤分级(χ2=6.985,P=0.030)是影响局部晚期Luminal A型乳腺癌患者5年无瘤生存的因素;多因素分析结果显示:T分期(HR=5.062,P<0.001)和N分期(HR=7.075,P<0.001)是局部晚期Luminal A型乳腺癌患者5年无瘤生存的影响因素,T分期和N分期越晚,5年无瘤生存情况越差。结论T分期和N分期是局部晚期Luminal A型乳腺癌患者预后的独立危险因素,个体化的综合治疗方案是提高患者5年无瘤生存率的重要保障。

Clinicopathological characteristics and prognosis of patients with locally advanced Luminal A breast cancer

Objective To compare the clinicopathological features of Luminal A breast cancer patients in early and middle stage,and locally advanced Luminal A breast cancer,then the influencing factors of disease-free survival(DFS)in locally advanced Luminal A breast cancer patients were further discussed.Methods From January 2010 to December 2012,295 Luminal A breast cancer patients who completed diagnosis,treatment,and follow-up in our hospital were retrospectively collected.According to TNM stage,227 cases of early and middle breast cancer and 68 cases of locally advanced breast cancer were divided into two groups.Chi-square test or rank sum test was used to compare the clinicopathological characteristics of patients between the two groups,and log-rank test and Cox proportional risk regression model were used to explore the influencing factors of 5-year DFS situation in patients with locally advanced Luminal A breast cancer.Results T stage and N stage were later in locally advanced Luminal A breast cancer patients than that of the early and middle breast cancer patients(P<0.05),and the tumor grade was higher in locally advanced Luminal A breast cancer patients(P<0.05).The 5-year DFS rate was 87.8%(259/295).In this study,there were 5 comprehensive treatment schemes as follows:neoadjuvant chemotherapy+surgery+radiotherapy+endocrine therapy,neoadjuvant chemotherapy+surgery+endocrine therapy,surgery+chemotherapy+radiotherapy+endocrine therapy,surgery+chemotherapy+endocrine therapy,and surgery+radiotherapy+endocrine therapy.The 5-year DFS rate of locally advanced Luminal A breast cancer patients was lower than that of the early and middle Luminal A breast cancer patients(76.5%vs.91.2%,P=0.001).Univariate analysis showed that T stage(χ2=8.248,P=0.040),N stage(χ2=9.470,P=0.024),vascular invasion(χ2=4.211,P=0.031),and tumor grade(χ2=6.985,P=0.030)were the factors influencing the 5-year DFS situation of locally advanced Luminal A breast cancer patients.Multivariate analysis showed that T staging(HR=5.062,P<0.001)and N staging(HR=7.075,P<0.001)were the influencing factors for 5-year DFS situation in locally advanced Luminal A breast cancer patients.The later the T stage and N stage,the worse the 5-year DFS situation.Conclusions T stage and N stage are independent risk factors for prognosis of patients with locally advanced Luminal A breast cancer.Individualized comprehensive treatment program is an important guarantee for improving the 5-year DFS rate of this kind of patients.