早期乳腺癌复发、转移危险因素分析

目的 分析早期乳腺癌复发转移的危险因素,为早期乳腺癌个体化治疗提供依据.方法 分析广东省中山市人民医院2002～2008年收治的650例早期乳腺癌患者的临床、病理及免疫组化资料,随访观察患者的复发、转移情况.Kaplan-Meier法计算患者无瘤生存率,Log-rank检验对可能影响患者预后的相关因素进行分析,COX模型进行多因素分析.结果 3、5年无瘤生存率分别为96.7％ 、91.7％.单因素统计分析发现,肿瘤分期、大小,淋巴结转移,病理类型,CerbB-2,Ki-67可显著影响乳腺癌转移、复发情况（P＜0.05）;术后联合化疗、放疗或内分泌治疗均可降低复发转移率（P＜ 0.05）;COX分析显示,肿瘤分期（RR=2.39,95％CI=1.14～4.71）,肿瘤大小（RR=3.92,95％CI=1.05～5.53）,淋巴结转移（RR=2.23,95％CI=1.21～3.92）,病理类型（RR=1.14,95％CI=1.01～5.78）,CerbB-2阳性（RR=1.49,95％CI=1.13～7.76）,Ki-67（RR=1.69,95％CI=1.04～6.77）,化疗（RR=1.59,95％CI=1.21～4.47）,放疗（RR=1.74,95％CI=1.11～6.23）,内分泌治疗（RR=1.95,95％CI=1.18～6.42）是影响患者5年无瘤生存率的因素（P＜0.05）.结论 肿瘤分期晚、肿块大、存在淋巴结转移、病理类型为浸润性、CerbB-2及Ki-67阳性是早期乳腺癌发生复发转移的危险因素;而术后联合化疗、放疗及内分泌治疗均可显著降低患者复发、转移率.对于存在上述危险因素的患者,应根据实际情况选择合适的个体化治疗方案,降低复发转移率.

Risk factors analysis of early breast cancer

Objective To investigate the prognosis factors of early breast cancer.Methods The clinical,pathological and immunohistochemical data of 650 cases with early breast cancer from 2002 to 2008 in the People＇s Hospital of Zhongshan,Guangdong Province were analyzed and the recurrence and metastasis was observed by follow-up.The disease-free survival rates was analyzed by Kaplan-Meier method and the possible risk factors were compared by Log-rank test,then the risk analysis was executed by COX model.Results The 3 and 5-year disease-free survival rates of these patients were 96.7％,91.7％.Univariate analysis showed that tumor stage,size,lymph node metastasis,histological type,CerbB-2 and Ki-67 can significantly affect the disease-free survival rates （P ＜ 0.05）; while postoperative chemotherapy or radiotherapy or hormonal therapy can reduce disease-free survival rates （P ＜ 0.05）.COX regression analysis showed that Tumor stage （RR =2.39,95％ CI =1.14-4.71）; tumor size （RR =3.92,95％ CI =1.05-5.53）; lymph node metastasis （RR =2.23,95％ CI =1.21-3.92）;pathological type （RR =1.14,95％ CI =1.01-5.78）; CerbB-2-positive （RR =1.49,95％ CI =1.13-7.76）; Ki-67 （RR =1.69,95％ CI =1.04-6.77）; chemotherapy （RR =1.59,95％ CI =1.21-4.47）; radiotherapy （RR =1.74,95％ CI =1.11-6.23） and endocrine therapy （RR =1.95,95％ CI =1.18-6.42） were the factors that could affect 5-year disease-free survival rates （P ＜ 0.05）.Conclusion The early breast cancer patients with late tumor stage,tumor large,lymph node metastasis,pathological type is invasive,CerbB-2 and Ki-67-positive were the risk factors of recurrence and metastasis; while postoperative chemotherapy,radiotherapy and hormonal therapy can significantly reduce recurrence and metastasis rate.So for the patients with such risk factors,individualized treatment programs should be choosen according to the actual situation to reduce recurrence and metastasis rates.