论文部分内容阅读
目的:探讨年龄对乳腺癌患者保留乳房治疗后长期复发及生存结局的影响。方法:从北京大学肿瘤医院乳腺癌预防治疗中心数据库中回顾性收集1999年12月至2014年12月2 778例原发性乳腺癌保留乳房治疗病例的资料，中位年龄47岁（范围：21~91岁）。根据发病年龄将患者分为≤40岁组（677例）与>40岁组（2 101例），比较两组患者的临床特征。采用Kaplan-Meier法绘制生存曲线，并用Log-rank法比较两组局部复发率、无远处转移动生存（DDFS）、无病生存（DFS）及乳腺癌特异性生存（BCSS），采用Cox比例风险模型分析复发及生存的预后因素。结果:≤40岁组和>40岁组的激素受体阳性比例（490/677比1 581/2 101，χ2=6.981，n P=0.030）、腋窝淋巴结阳性比例（314/677比713/2 101，χ2=34.966，n P40岁组10年DDFS率分别为90.6%和95.3%（n P0.05）；淋巴结状态（阳性比阴性，n HR=2.73，n 95%CI：1.94~3.84，n P40岁，n HR=1.73，n 95%CI：1.24~2.42，n P=0.001）、肿瘤最大径（>2 cm比≤2 cm，n HR=1.61，95%n CI：1.14~2.28，n P=0.001）是DDFS和DFS的独立预后因素；激素受体状态（阳性比阴性，n HR=0.54，n 95%CI：0.39~0.74，n P40岁乳腺癌患者保留乳房治疗后局部复发风险相似，前者长期生存劣于后者。“,”Objective:To examine the difference of long-term recurrence rate and survivals between the young patients and the old patients undergoing breast conserving therapy (BCT).Methods:Women with primary invasive breast cancer receiving BCT between December 1999 and December 2014 were selected retrospectively from the database of Breast Cancer Center, Peking University Cancer Hospital & Institute. The median age of all patients was 47 years (range: 21 to 91 years). The cases were categorized according to age at diagnosis into two subgroups: the ≤40 years group and the>40 years group. A total of 2 778 patients were included: 677 patients in the ≤40 years group and 2 101 patients in the >40 years group. Clinicopathological characteristics between two groups were compared. The recurrence rate and survival were calculated using the Kaplan-Meier method. The differences of outcomes were compared in different aged groups using the Log-rank test. Factors affecting local recurrence, distant disease-free survival (DDFS), disease-free survival (DFS), and breast cancer-specific survival (BCSS) were assessed by multivariable Cox proportional hazard models.Results:Proportions of T1 (301/677 n vs. 1 160/2 101, χ2=37.660, n P40 years group was 90.6% and 95.3%, respectively (n P40 years group was 86.5% and 91.1%, respectively (n P=0.001). Ten-year BCSS rate in the ≤40 years group and in the>40 years group was 91.0% and 93.7%, respectively (n P=0.105). Age was not the prognosis factor of local recurrence. Lymph node status (positive n vs. negative: n HR=2.73, n 95%CI: 1.94 to 3.84, n P40 years:n HR=1.73, n 95%CI:1.24 to 2.42, n P=0.001) and T stage (>2 cmn vs. ≤2 cm: n HR=1.61, n 95%CI: 1.14 to 2.28, n P=0.001) were the prognosis factors of DDFS, and also for DFS. Hormone receptor status (positive n vs. negative: n HR=0.54, n 95%CI: 0.39 to 0.74, n P40 years patients receiving breast conserving therapy. Worse survivals in the ≤40 years group were found comparing to those in the >40 years group.