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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2012, Vol. 06 ›› Issue (02) : 168 -177. doi: 10.3877/cma. j. issn.1674-0807.2012.02.007

论著

三阴性乳腺癌TNM 分期的临床特点及影响预后的危险因素
张毅1,†(), 张颖2, 修海清1, 李玉军3, 王海波4, 梁军5   
  1. 1.266003 青岛, 青岛大学医学院附属医院健康体检中心
    2.青岛市市南区社区卫生服务中心
    3.266003 青岛, 青岛大学医学院附属医院病理科
    4.266003 青岛, 青岛大学医学院附属医院乳腺外科
    5.266003 青岛, 青岛大学医学院附属医院肿瘤科
  • 收稿日期:2011-03-09 出版日期:2012-04-01
  • 通信作者: 张毅

Clinical features of TNM staging of triple negative breast cancer and risk factors affecting its prognosis

Yi ZHANG1,†(), Ying ZHANG1, Hai-qing XIU1, Yu-jun LI1, Haibo WANG1, Jun LIANG1   

  1. 1.Department of the Health Examination Center, the Affiliated Hospital of Medical College, Qingdao University,266003 Qingdao, China
  • Received:2011-03-09 Published:2012-04-01
  • Corresponding author: Yi ZHANG
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引用本文：

张毅, 张颖, 修海清, 李玉军, 王海波, 梁军. 三阴性乳腺癌TNM 分期的临床特点及影响预后的危险因素[J/OL]. 中华乳腺病杂志(电子版), 2012, 06(02): 168-177.

Yi ZHANG, Ying ZHANG, Hai-qing XIU, Yu-jun LI, Haibo WANG, Jun LIANG. Clinical features of TNM staging of triple negative breast cancer and risk factors affecting its prognosis[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2012, 06(02): 168-177.

目的

探讨三阴性乳腺癌(TNBC)TNM 分期的临床特点及影响预后的独立危险因素。

方法

收集2005 年1 月至2007 年6 月在本院经临床诊断并手术病理证实的429 例女性乳腺癌患者。 TNBC 患者98 例,其余331 例为非三阴性乳腺癌(NTNBC)患者。 按照IUCC/AJCC 第6 版乳腺癌TNM 分期标准两组患者进行分期并对比分析。 病理生物学行为和TNM 分期的比较采用χ2 检验或秩和检验。 生存分析采用Kaplan-Meier 法、绘制生存曲线。 影响TNBC 预后的危险因素分析采用Cox 比例风险回归模型。

结果

本组TNBC 占同期乳腺癌的22.84% (98/429),NTNBC 占77.16%(331/429)。 TNBC 组与NTNBC 组比较,在肿瘤组织学分级(Ⅲ级41.84% 比21.45%)、组织病理学分类(浸润性导管癌73.47%比59.82%)、术后肿瘤局部复发(27.55%比13.29%)、肿瘤大小(直径＞5 cm,41.84%比25.08%)、区域淋巴结转移(56.12%比39.88%)和远处脏器转移(25.51%比12.69%)的差异均有显著的统计学意义(P ＜0.050)。 在TNM 分期中,TNBC 组与NTNBC 组比较,Ⅰ期(8.16% 比16.01%)、Ⅱa 期(17.35%比26.28%)、Ⅱb 期(17.35%比26.89%),差异无统计学意义(P＞0.050);而在Ⅲa 期(24.49%比15.71%)、Ⅲb 期(12.25%比6.04%)、Ⅲc 期(9.18%比3.93%)和Ⅳ期(11.22%比5.14%),TNBC 组所占的比例高于NTNBC 组(P＜0.050)。 TNBC 组与NTNBC 组比较,5 年总生存率(76.53%比89.73%)和5 年无瘤生存率(63.27%比74.32%)差异有显著统计学意义(P＜0.050)。 TNBC 组的中位生存期为54.08 个月(95% CI 48.880 ～59.283), NTNBC 组为59.00 个月(95% CI 51.515 ～63.849)。 影响TNBC 预后的独立危险因素Cox 回归分析结果显示,TNM 分期中的Ⅲ、Ⅳ期、区域淋巴结转移和远处脏器转移是影响TNBC 患者预后的独立危险因素。

结论

乳腺癌TNM 分期能够反映TNBC 的侵袭性和复发转移的临床特点,Ⅲ期、Ⅳ期和区域淋巴结转移以及远处脏器转移是影响TNBC 预后的独立危险因素,其中远处脏器转移是导致TNBC 患者死亡最主要的危险因素。

关键词: 乳腺肿瘤, 三阴性, TNM 分期, 预后因素

Objective

To analyze the clinical features of TNM staging of triple negative breast cancer (TNBC)and risk factors affecting its prognosis.

Methods

From January 2005 to June 2007 a total of 429 breast cancer patients confirmed pathologically after operation in our hospital were collected in this study. Among them 98 patients were diagnosed as triple negative breast cancer (TNBC) and the rest 331 as non-triple negative breast cancer (NTNBC). All patients were staged according to the staging system (IUCC/AJCC, the 6th edition) and the two groups of patients were compared and analyzed.Comparison of pathobiological behaviours and TNM stages between the two groups was done using chi-square test or rank sum test. Kaplan-Meier method, drawing survival curve and Log-rank test were used for survival analysis. Cox regression was used for analysis of death risk factors for TNBC patients.

Results

TNBC patients accounted for 22.84% (98/429)and NTNBC for 77.16% (331/429). The comparison between the TNBC group and the NTNBC group showed significantly statistical difference in histology grade (grade Ⅲ,41.84% vs 21.45%), pathobiological types ( invading ductal cancer, 73.47% vs 59.82%), local recurrence after operation (27.55% vs 13.29%), tumor diameter(maximum diameter of primary tumor ＞5 cm,41.84% vs 25.08%),metastasis of lymph nodes (56.12% vs 39.88%)and organ metastasis (25.51% vs 12.69%) (P ＜0.050).The comparison of TNM stage between the TNBC group and the NTNBC group showed no statistical difference in stage I (8.16% vs 16.01%), stage IIa (17.35% vs 26.28%) and stage IIb (17.35% vs 26.89%) (P ＞0.050),but significant difference in stage Ⅲa(24.49% vs 15.71%),stage Ⅲb (12.25% vs 6.04%),stage Ⅲc (9.18% vs 3.93%)and stage Ⅳ(11.22% vs 5.14%)(P＜0.050). The 5-year overall survival and disease free survival in the TNBC group was markedly lower than in the NTNBC group ( 76.53% vs 89.73% and 63.27% vs 74.32% )( P ＜0.050). The median survival time was 54.082 months (95% CI 48.880 ～59.283) in the TNBC group and 59.000 months (95% CI 51.515 ～63.849) in the NTNBC group. TNM stage Ⅲ, Ⅳ(χ2 =5.094,P=0.024) and lymph node metastasis(χ2 = 4.375,P = 0.036) and organ metastasis (χ2 = 6.064,P =0.012) were the risk factors affecting the prognosis of TNBC patients.

Conclusion

The TNM staging system for breast cancer well reflect the clinical features of invasion, recurrence and metastasis of TNBC. TNM stage Ⅲand Ⅳ, lymph node metastasis and organ metastasis are dependent factors affecting the prognosis, and distant metastasis is the most important factor of death for TNBC.

Key words: breast neoplasms, triple negative, TNM stage, prognosis factors
表1 两组乳腺癌病理生物学行为的比较
病理因素 TNBC组[(n=98),例(%)] NTNB组[(n=331),例(%)] 统计量 P值
肿瘤组织学分级 -15.785 0.000a
Ⅰ级 19(19.39) 75(22.66)
Ⅱ级 38(38.76) 185(55.89)
Ⅲ级 41(41.84) 71(21.45)
组织病理学分类 6.041 0.049b
浸润性导管癌 72(73.47) 198(59.82)
浸润性小叶癌 13(13.27) 67(20.24)
其他类型癌 13(13.26) 66(19.94)
术后肿瘤局部复发 11.130 0.001b
有复发 27(27.55) 44(13.29)
无复发 71(72.45) 287(86.71)
肿瘤大小 -15.645 0.000a
≤2cm 19(19.39) 80(24.17)
2cm～5cm 38(38.78) 168(50.76)
＞5cm 41(41.84) 83(25.08)
区域淋巴结状态 8.133 0.004b
阳性(转移) 55(56.12) 132(39.88)
1～3枚 21(21.43) 54(16.31)
4～9枚 20(20.41) 49(14.80)
≥10枚 14(14.29) 29(8.76)
阴性(无转移) 43(43.88) 199(60.12)
远处脏器转移 9.432 0.002b
有转移 25(25.51) 42(12.69)
肺 9(9.18) 12(3.63)
肝 7(7.14) 11(3.32)
脑 5(5.10) 8(2.42)
骨 2(2.04) 6(1.81)
≥2个脏器 2(2.04) 5(1.51)
无转移 73(74.49) 289(87.31)
表2 两组乳腺癌TNM 分期及5 年的OS 和DFS
TNM分期 TNBC组[(n=98),例(%)] NTNBC组[(n=331),例(%)] χ 2值 P值
Ⅰ期T1N0M0 8(8.16) 53(16.01) 3.891 0.051
Ⅱa期 17(17.35) 87(26.28) 3.288 0.070
T0N1M0 6(6.12) 26(7.85)
T1N1M0 6(6.12) 29(8.76)
T2N0M0 5(5.10) 32(9.67)
Ⅱb期 17(17.35) 89(26.89) 3.700 0.054
T2N1M0 9(9.18) 43(12.99)
T3N0M0 8(8.16) 46(13.90)
Ⅲa期 24(24.49) 52(15.71) 3.998 0.046
T0N2M0 5(5.10) 11(3.32)
T1N2M0 6(6.12) 13(3.93)
T2N2M0 7(7.14) 15(4.53)
T3N1-2M0 6(6.12) 13(3.93)
Ⅲb期T4N0-2M0 12(12.25) 20(6.04) 4.214 0.040
Ⅲc期T1-4N3M0 9(9.18) 13(3.93) 4.294 0.038
Ⅳ期T1-4N1-3M1 11(11.22) 17(5.14) 4.954 0.032
5年OS 75(76.53) 297(89.73) 11.431 0.001
5年DFS 62(63.27) 246(74.32) 4.563 0.033
图1 三阴性乳腺癌(TNBC)组与非三阴性乳腺癌(NTNBC)组的生存曲线比较 χ2=7.675,P=0.002,Log-rank Test
图2 三阴性乳腺癌(TNBC)组与非三阴性乳腺癌(NTNBC)组的无瘤生存曲线比较 χ2=9.853,P=0.001,Log-rank Test
表3 两组乳腺癌患者的生存时间均数与中位生存期
组别 例数 生存时间均数 中位生存期
(月) SE 95%CI (月) SE 95%CI
TNBC组 98 61.54 1.526 58.550～64.532 54.08 2.564 48.880～59.283
NTNBC组 331 66.12 0.528 65.080～67.149 59.00 2.474 51.515～63.849
合计 429 65.07 0.554 64.004～66.136 56.54 2.270 56.551～65.449
表4 影响三阴性乳腺癌预后的危险因素Cox 回归分析
项目 B SE df χ 2值 P值 Exp 95%CI
浸润性导管癌 -4.329 1.170 1 13.885 0.066 0.081 0.007～1.168
组织学级 -3.646 1.037 1 15.852 0.089 0.061 0.001～1.696
Ⅲ～Ⅳ期 0.581 0.258 1 5.094 0.024 1.788 1.097～2.962
术后肿瘤复发 -3.779 0.808 1 11.866 0.073 0.089 0.005～0.111
肿瘤直径 -3.598 1.000 1 12.946 0.071 0.087 0.004～0.194
区域淋巴结转移 0.514 0.246 1 4.375 0.036 1.673 1.033～2.709
远处脏器转移 0.618 0.271 1 6.046 0.012 1.979 1.167～3.045
[1]
Perou CM, Sørlie T, Eisen MB,et al. Molecular portraits of human breast tumors[J]. Nature,2000,406(6797):747-752.
[2]
齐晓伟.三阴性乳腺癌研究进展[J].中华乳腺病杂志:电子版,2008,2 (5):612-617.
[3]
毛伟征,苏东明,李雪萍,等. AJCC 癌症分期手册(第六版)[M].沈阳市:辽宁科学技术出版社,2005:221-240.
[4]
张保宁,张慧明.三阴性乳腺癌研究进展:第31 届圣.安东尼奥乳腺癌研讨会报道[J].中华乳腺病杂志:电子版,2009,3(1):5-8.
[5]
Singletary SE, Connolly JL. Breast cancer staging: working with the sixth edition of the AJCC. Cancer Sung Marual [J].CA Cancer J Clin,2006,56(1):37-47.
[6]
Rakha EA,El-Sayed ME,Green AR,et al. Prognostic markers in triple-negative breast cancer [J]. Cancer,2007,109(1):25-32.
[7]
Banerjee S, Reis-Filho JS, Ashley S, et al. Basal-like breast carcinomas: clinical outcome and response to chemotherapy[J]. J Clin Pathol,2006,59(7):729-735.
[8]
Rottenberg S,Jaspers JE,Kersbergen A,et al. High sensitivity of BRCA1-deficient mammary tumors to the PARP inhibitor AZD2281 alone and in combination with platinum drugs [J]. Proc Natl Acad Sci USA,2008,105 (44):17079-17084.
[9]
张毅,王燕,李玉军,等.三阴性乳腺癌的临床病理学特点及其预后影响因素[J]. 中华普通外科学文献:电子版,2010,4(4):31-34.
[10]
Conlin AK, Seidman AD. Beyond cytotoxic chemotherapy for the first-line treatment of HER2-negative, hormoneinsensitive metastatic breast cancer: current status and future opportunities [J]. Clin Breast Cancer,2008,8(3):215-223.
[11]
Kahn HJ,Hanna WM,Chapman JA,et al. Biological significance of occult micrometastases in histologically negative axillary lymph nodes in breast cancer patients using the recent American Joint Committee on Cancer breast cancer staging system[J]. Breast J,2006,12 (4):294-301.
[12]
Bauer KR, Brown M, Cress RD, et al. Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor(PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from the California cancer Registry [J]. Cancer,2007,109(9):1721-1728.
[13]
张毅,王燕,曹永献,等. HER-2、ER 和PR 阴性乳腺癌的病理生物学特性及其影响预后的因素[J].中国医师杂志,2010,12(11):1462-1466.
[14]
Yin WJ, Lu JS, Di GH, et al. Clinicopathological features of the triple-negative tumors in Chinese breast cancer patients[J]. Breast Cancer Res Treat,2009,115(2):325-333.
[15]
张伟,任敏,王本忠.三阴性乳腺癌研究进展[J].中华内分泌外科杂志,2009,(3):187-189.
[16]
Woodward WA, Strom EA, Tucker SL, et al. Changes in the 2003 American Joint Committee on Cancer staging for breast cancer dramatically affect stage-specific survival [J]. J Clin 0ncol,2003,21(17):3244.
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