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目的探讨青年女性乳腺癌临床病理学特征,分析临床治疗选择与预后的关系。方法回顾性分析自2008年1月至2014年12月北京大学第一医院乳腺疾病中心经治的乳腺癌病例,比较同期青年组(<35岁)与年长组(≥35岁)的临床病理学差异,探讨青年女性乳腺癌临床病理学特征与预后之间的相关性,绘制Kaplan-Meier曲线计算生存期,通过Log-rank检验进行单因素分析,并行Cox模型多因素分析,应用后退法筛选影响生存的危险因素。结果青年女性乳腺癌110例,占全部乳腺癌的5.7%,中位年龄32(21~34)岁,与同时期≥35岁病人相比较,两组Luminal A型、Luminal B型(HER2阴性)分布差异有统计学意义(P<0.001)。青年女性乳腺癌临床分期、原位癌发病率、HR阳性及HER2阳性乳腺癌所占比例与≥35岁病人差异均无统计学意义。青年女性乳腺癌病人选择保乳手术、全乳房切除联合成形手术的比例与≥35岁病人差异具有统计学意义(P<0.001)。中位随访时间31.5(8~78)个月,5年存活率93.3%,5年无进展存活率89.3%。单因素及多因素分析显示,青年女性乳腺癌无进展生存期与N分期(P<0.001)、M分期(P<0.001)相关,总生存期与N分期相关(P<0.001)。结论青年女性乳腺癌具有独特的临床病理学特点,在强化内分泌治疗的同时应注意生育保护,由于对外形、生活质量要求更高,青年女性乳腺癌的外科手术方式需要个体化选择。
Objective To investigate the clinicopathological features of breast cancer in young women and to analyze the relationship between clinical treatment options and prognosis. Methods The clinical data of breast cancer patients treated by the Breast Disease Center of Peking University First Hospital from January 2008 to December 2014 were retrospectively analyzed. The clinical symptoms of young patients (<35 years old) and elderly patients (≥35 years old) To explore the relationship between clinicopathological characteristics and prognosis of young women with breast cancer, Kaplan-Meier curve was drawn to calculate the survival, single-factor analysis by Log-rank test, multivariate analysis of Cox model and screening by backward method Risk factors that affect survival. Results There were 110 cases of breast cancer in young women, accounting for 5.7% of all breast cancers, with a median age of 32 (21-34) years. Compared with patients of the same period ≥35 years, two groups of Luminal A, Luminal B (HER2 negative) The distribution difference was statistically significant (P <0.001). The clinical staging of young women with breast cancer, the incidence of carcinoma in situ, HR positive, and the proportion of HER2 positive breast cancer were not significantly different from those of patients ≥35 years old. The ratio of breast conserving surgery and total mastectomy combined with plastic surgery in young female patients with breast cancer was significantly different from that of patients ≥35 years old (P <0.001). The median follow-up time was 31.5 (ranged from 8 to 78) months, with a 5-year survival rate of 93.3% and a 5-year progression-free survival rate of 89.3%. Univariate and multivariate analysis showed that progression-free survival of young women with breast cancer was correlated with N stage (P <0.001) and M stage (P <0.001), and overall survival was related to N stage (P <0.001). Conclusion The young female breast cancer has a unique clinicopathological features. At the same time, we should pay attention to the protection of childbirth while strengthening the endocrine therapy. Because of the requirement of appearance and quality of life, the breast cancer surgical methods of young women need individualized selection.