目的

回顾性分析与年轻乳腺癌患者预后有关的临床病理、生物学特征,评估与远处转移潜能相关的因素。

方法

收集本院乳腺科1994 年1 月至1998 年4月确诊的年龄≤35岁的原发性乳腺癌患者191例,其中93例临床资料及随访工作完整,并且93 例中63 例肿瘤蜡块可用于生物学指标的免疫组化染色。手术方式包括保乳手术、改良根治术及经典根治术。所有患者按国际抗癌联盟(UICC)1997 年临床分期标准分期。复习病理切片,包括组织学分类及分级、淋巴管侵犯、淋巴结外软组织受累、广泛性导管内成分和淋巴结受累。免疫组化方法检测雌激素受体、孕激素受体、雄激素受体(AR)、c-erbB-2、ki67及P53蛋白表达。术后依据病理及生物学指标给予辅助放射治疗、化疗和内分泌治疗。将93 例病例按5 年是否转移分为2 组,将预后相关因素分为临床、病理及生物学因素。计量资料采用χ² 检验进行5年转移率趋势分析,转移危险因素分析采用多因素COX 回归模型,检验水准a=0.05。

结果

随访至5 年,术后5 年远处转移26例,转移率为28.0%(26/93)。临床分期III期、行经典根治术治疗者5 年转移率最高(分别为60.7%及43.8%,P＜0.01)。淋巴结受累1～3、4～6、＞6 枚的远处转移风险是淋巴结阴性的2.04、3.33、14.63 倍,淋巴结外软组织受累的转移风险是未受累的2.41 倍,AR 阳性是阴性的0.15 倍,c-erbB-2(+)、分别是c-erbB2(-)的13.51、10.39、12.20 倍。

结论

年轻的晚期乳腺癌患者预后较差,人为干预手段不能从根本上影响预后,病理指标中淋巴结及结外软组织受累情况、生物学因素中AR 及c-erbB-2 表达情况是预测远处转移风险的较佳因素。

Objective

To retrospectively analyze the relationship between clinicopathological and biological characteristics and the outcome in young females with breast cancer and evaluate the relative factors of distant metastasis.

Methods

The data of 191 cases of≤35-year-old women with primary breast cancer treated from January 1994 to April 1998 in Tianjin Cancer Hospital were retrospectinely analyzed.The follow-up clinical data of 93 of the 191 cases were complete.Sixty-three samples were available for immunohistochemical analyses.The surgical operation included breast-conserving therapy,modified mastectomy and radical mastec-tomy.Clinical staging were consistent with the 1997 UICC TNM classification.The histological specimens were reviewed.The pathological parameters including pathological type,histological grade,lymphatic vessel invasion,fat involvement,extensive intraductal component and lymph node status were determined.Various biological factors including estrogen receptor(ER),progesterone receptor(PR),androgen receptor(AR),c-erbB-2,ki67 and p53 were tested with immunohistochemistry.The adjuvant radiation therapy,chemotherapy and hormonal therapy after operation were carried out on the basis of pathological and biological features.The 93 cases were divided into two groups according to metastasis and non-metastasis within 5 years.The prognosis-related factors including clinical factors,pathological and biological factors were evaluated.Chi-square test was used for analysis of 5-years metastasis status;and multivariate analysis was carried out using Cox proportional hazards models to assess the independent effect of the metastasis factors(the test standard a=0.05).

Results

The 5-year follow-up showed that the metastasis rate in the 93 cases was 28.0% (26/93).The Chi-square test results indicated that the patients with clinical stage III undergoing radical mastectomy had the highest metastasis rate(60.7%and 43.8%respectively,P＜0.01).Cox-regression results showed that patients with 1-3,4-6 and＞6 positive lymph nodes had a higher risk of metastasis than the patients with negative lymph nodes,and RR values were 2.04,3.33 and 14.63 respectively.The metastasis risk of patients with fat involvement was 2.41 times of the patients without fat involvement.The metastasis risk of patients with AR positive was 0.15 times of the patients with AR negative,and the metastasis risk of c-erbB-2(+),and was 13.51,10.39 and 12.20 times of the patients with c-erbB-2(-)respectively.

Conclusions

The young patients with clinical advanced breast cancer have a poor outcome.The therapeutic intervention has no fundamental impact on the outcome of patients.The lymph node and fat involvement status,AR and c-erbB-2 expression are the factors predicting the distant metastasis risk for young patients with breast cancer.