Analysis of relative factors of distant metastasis in young breast cancer patients

doi:10.3877/cma.j.issn.1674-0807.2009.02.006

Abstract

Abstract:

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.

Key words: Breast neoplasms, Neoplasm metastasis, Young age

Jie MENG, Jin ZHANG. Analysis of relative factors of distant metastasis in young breast cancer patients[J]. Chinese Journal of Breast Disease(Electronic Edition), 2009, 03(02): 163-172.

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Figures/Tables 10

References 15

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因素	未转移组(例)	转移组(例)	χ²值	P值
临床分期			20.17	0.00
0期	2	0
I期	15	1
II期	39	8
III期	11	17
术式			12.01	0.00
保乳手术	3	0
改良根治术	37	5
经典根治术	27	21
组织学分级			7.99	0.02
I	10	1
II	35	10
III	17	15
淋巴管侵犯			14.13	0.00
-	57	12
+	9	12
++	1	2
结外软组织受累			18.12	0.00
-	54	9
+	13	17
淋巴结状况			38.09	0.00
-	37	3
1-3	21	4
4-6	5	2
＞6	4	17
雄激素受体			4.76	0.03
-	19	13
+	23	4
c-erbB-2			34.87	0.00
-	34	0
+	2	4
	5	10
	2	3

因素	未转移组(例)	转移组(例)	χ²值	P值
临床分期			20.17	0.00
0期	2	0
I期	15	1
II期	39	8
III期	11	17
术式			12.01	0.00
保乳手术	3	0
改良根治术	37	5
经典根治术	27	21
组织学分级			7.99	0.02
I	10	1
II	35	10
III	17	15
淋巴管侵犯			14.13	0.00
-	57	12
+	9	12
++	1	2
结外软组织受累			18.12	0.00
-	54	9
+	13	17
淋巴结状况			38.09	0.00
-	37	3
1-3	21	4
4-6	5	2
＞6	4	17
雄激素受体			4.76	0.03
-	19	13
+	23	4
c-erbB-2			34.87	0.00
-	34	0
+	2	4
	5	10
	2	3

因素	Wald	RR	95%CI	P值
淋巴结状况
阴性	24.13			0.00
1-3	0.88	2.04	(0.46-9.13)	0.35
4-6	1.69	3.33	(0.54-20.51)	0.19
＞6	16.84	14.63	(4.06-52.71)	0.00
软组织受累
-/+	3.98	2.41	(1.01-5.73)	0.04
雄激素受体
-/+	5.86	0.15	(0.03-0.69)	0.02
c-erbB-2
阴性	8.11			0.04
+	3.99	13.51	(1.05-173.33)	0.04
	7.32	10.39	(1.91-56.60)	0.01
	5.22	12.20	(1.43-104.41)	0.02

因素	Wald	RR	95%CI	P值
淋巴结状况
阴性	24.13			0.00
1-3	0.88	2.04	(0.46-9.13)	0.35
4-6	1.69	3.33	(0.54-20.51)	0.19
＞6	16.84	14.63	(4.06-52.71)	0.00
软组织受累
-/+	3.98	2.41	(1.01-5.73)	0.04
雄激素受体
-/+	5.86	0.15	(0.03-0.69)	0.02
c-erbB-2
阴性	8.11			0.04
+	3.99	13.51	(1.05-173.33)	0.04
	7.32	10.39	(1.91-56.60)	0.01
	5.22	12.20	(1.43-104.41)	0.02

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