2022 年第 3 期 第 17 卷

老年女性乳腺癌患者的临床特征及预后分析

Analysis of clinical characteristics and prognosis of elderly female patients with breast cancer

作者：陶振洲秦薛斌曹广骆成玉纪智礼

英文作者：Tao Zhenzhou Qin Xuebin Cao Guang Luo Chengyu Ji Zhili

单位：首都医科大学附属北京安贞医院普外科，北京100029

英文单位：Department of General Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：乳腺癌；淋巴结转移；乳腺癌分子分型

英文关键词：Breastcancer;Lymphnodemetastasis;Moleculartypingofbreastcancer

• 摘要：

• 目的 分析70岁及以上老年女性乳腺癌患者的临床特点及预后。方法  回顾性分析2006年6月至2016年7月首都医科大学附属北京安贞医院收治的238例70岁及以上老年女性乳腺癌患者的临床资料。记录患者的临床特征，对患者进行术后随访并记录预后情况。采用Kaplan-Meier生存曲线分析方法计算不同临床特征患者5年总生存率和5年无病生存率，分析影响患者生存率的危险因素。结果 238例患者中，214例（89.9%）患者以无痛性乳房肿块为主要就诊症状；202例（84.9%）为浸润性导管癌；63例（26.5%）肿瘤直径≤2 cm、149例（62.6%）肿瘤直径＞2～5 cm、26例（10.9%）肿瘤直径＞5 cm；56例（23.5%）淋巴结转移数量≥4个；85例（35.7%）肿瘤分期Ⅰ期、123例（51.7%）肿瘤分期Ⅱ期、30例（12.6%）肿瘤分期Ⅲ期；54例（22.7%）分子分型为Luminal A型、98例（41.2%）为Luminal B型/人表皮生长因子受体2（HER-2）阴性、26例（10.9%）为Luminal B型/HER-2阳性、19例（8.0%）为HER-2过表达型、41例（17.2%）为三阴性。截至2016年10月，226例得到随访，随访率为95.0%，随访时间85（65，89）个月，随访期间37例患者死亡。Kaplan-Meier生存曲线分析结果显示，患者5年总生存率为90.5%、5年无病生存率为84.2%。多因素Cox回归分析结果显示，淋巴结转移（相对危险度=1.549，95%置信区间：1.213~2.761，P=0.018）、分子分型（相对危险度=8.460，95%置信区间：1.437~8.462，P=0.006）是影响患者5年总生存率的独立危险因素，淋巴结转移（相对危险度=0.423，95%置信区间：0.146~1.924，P=0.002）是影响患者5年无病生存率的独立危险因素。结论  老年女性乳腺癌分子分型以Luminal A型及Luminal B型多见。淋巴结转移、分子分型是影响患者预后的独立危险因素。

• Objective   To analyze the clinical characteristics and prognosis of elderly female patients of 70 years and over with breast cancer. Methods   From June 2006 to July 2016, clinical data of 238 elderly female patients of 70 years and over with breast cancer admitted to Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. Clinical characteristics of patients were recorded. Patients were followed-up after surgery and whose prognosis was recorded. Kaplan-Meier survival curve analysis was used to calculate the 5-year overall survival rate and 5-year disease-free survival rate in patients with different clinical characteristics. Risk factors impacting survival rate were analyzed. Results  Among 238 cases, 214 cases (89.9%) had painless breast masses as the main first symptom; 202 cases (84.9%) had invasive ductal carcinoma; 63 cases (26.5%) had tumor size≤2 cm, 149 cases (62.6%) had tumor size＞2-5 cm and 26 cases (10.9%) had tumor size＞5 cm; 56 cases (23.5%) had the number of lymph node metastasis≥4; 85 cases (35.7%) had tumor stage Ⅰ, 123 cases (51.7%) had tumor stage Ⅱ and 30 cases (12.6%) had tumor stage Ⅲ; in molecular typing, 54 cases (22.7%) had Luminal A, 98 cases (41.2%) had Liminal B/human epidermal growth factor receptor-2 (HER-2) negative, 26 cases (10.9%) had Liminal B/HER-2 positive, 19 cases (8.0%) had HER-2 overexpression and 41 cases (17.2%) had triple-negative. As of October 2016, 226 cases were followed-up, the followed-up rate was 95.0%, the duration was 85（65，89） months and 37 cases dead during the period. Kaplan-Meier survival curve analysis showed that 5-year overall survival rate was 90.5% and 5-year disease-free survival rate was 84.2%. Multivariate Cox regression analysis showed that lymph node metastasis (risk rate=1.549, 95% confidence interval: 1.213-2.761, P=0.018) and molecular typing (risk rate=8.460, 95% confidence interval: 1.437-8.462, P=0.006) were independent risk factors impacting 5-year overall survival rate, and lymph node metastasis (risk rate=0.423, 95% confidence interval:0.146-1.924, P=0.002) was an independent risk factor impacting 5-year disease-free survival rate. Conclusion The molecular typing is mainly Luminal A and Luminal B types in elderly women with breast cancer. Lymph node metastasis and molecular typing were independent risk factors impacting patients′ prognosis.