摘要
目的分析10个以上淋巴结转移乳腺癌的临床特点、生存及影响预后的因素。方法回顾性分析中国医学科学院肿瘤医院自1998年1月至2002年3月收治的128例10个以上淋巴结转移乳腺癌患者临床资料，观察其生存，分析其临床特点及影响预后的因素。结果全组患者中位无病生存和总生存期分别为49和64个月，5年无病生存和总生存率分别是44．7％和53．1％。单因素分析显示，肿块大小与生存不相关；淋巴结转移个数大于20、转移淋巴结比例大于0．8和有脉管瘤栓者无病生存和总生存较差；受体阴性者总生存较差；放疗可改善无病生存，辅助化疗不低于4周期和内分泌治疗对无病生存和总生存均有改善；多发转移者生存明显低于局部复发者，亦低于单发转移者。多因素分析显示，转移淋巴结比例和脉管瘤栓是无病生存和总生存独立预后因素；辅助内分泌治疗可使复发和死亡风险分别下降43％和65％，放疗可使复发风险下降72％；4周期以上化疗可使死亡风险下降51％；复发转移者死亡风险明显升高，受体状态成为独立预后因素，积极解救治疗可改善生存。结论10个以上淋巴结转移乳腺癌具有高侵袭性生物学行为，预后与肿块大小无关，淋巴结转移比例、脉管瘤栓是重要的独立预后因素。积极的多学科治疗可以提高本组患者疗效，降低复发和死亡风险，改善生存。
Objective To analyze the clinical characteristics, survival, and prognosis of female breast cancer patients with 10 or more positive lymph nodes. Methods The data of 128 female breast cancer patients with 10 or more positive lymph nodes from JAN 1998 to Mar 2002 were retrospectively reviewed. The clinical characteristics, survival, and prognostic factors were analyzed by SPSS 10.0 statistic software. Results The 1-,3-,5, and 7-year overall survival （OS） rates were 91.4% , 68.8% , 53.1% , and 40.2% , and the disease free survival （DFS） rates were 80.9% , 54. 1% , 44.7% , and 36.0% respectively. Log Rank test showed that tumor size was not related to prognosis; patients with more than 20 positive lymph nodes （ P = 0. 029 ）, positive lymph node ratio greater than 0.8 （ P = 0. 027 ）, and infiltration of vessel （ P = 0. 037 ） had a poorer DFS and shorter OS ; patients with negative hormonal receptor had a poorer OS than those with positive hormonal receptor （ P = 0. 019 ） ; radiotherapy improved DFS （ P = 0. 000） , and adjuvant chemotherapy for 4 - 6 cycles （ P = 0. 000） or more than 6 cycles （ P = 0. 004 ） and endocrine therapy （P=0. 001） might improve DFS and OS; patients with multiple metastasis had a poorer survival than those with local recurrence （P = 0.004） and single metastasis （P = 0. 058）. COX proportional hazard model analysis showed that positive lymph node ratio and infiltration of vessel were independent prognostic factors for both DFS and OS; adjuvant endocrine therapy decreased relapse and death hazard ratio for 43% （ RR = 0.57,P = 0. 035 ） and 65% （ RR = 0.35, P = 0. 000） respectively; adjuvant radiotherapy decreased the relapse hazard ratio for 72% （ RR = 0.28, P = 0. 000 ） ; and adjuvant chemotherapy for more than 4 cycles decreased death hazard ratio for 51% （RR =0.49 ,P =0. 001 ）;patients with recurrence and/ or metastasis had a higher death hazard ratio （RR = 2. 738, P = 0. 000） , hormonal receptor was an independent prognostic factor , and active treatment might improve the survival. Conclusion Breastcancers with 10 or more positive lymph nodes have higher aggressively biologic characteristics; the prognosis of this subgroup has no relationship with tumor size and inverse correlation with the numbers of positive lymph nodes; Positive lymph node ratio and infiltration of vessel are important independent factors. Multidiscipline therapy including adjuvant radiotherapy, endocrine therapy, and at least 4 cycles chemotherapy increases the therapeutic effect, decreases relapse and death hazard ratio, and improves the survival.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2008年第2期77-81,共5页
National Medical Journal of China
基金
国家“863”高技术研究发展计划基金资助项目（2002AA2Z341J）
关键词
乳腺肿瘤
预后
淋巴结转移
综合治疗
Breast neoplasms
Prognosis
Positive lymph nodes
Combined therapy
