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三阴性乳腺癌(triple-negative breast cancer,TNBC)占乳腺癌总数的12%~20%[1],其雌激素受体(estrogen receptor, ER)、孕激素受体(progestogen receptor, PR)及人类表皮生长因子受体2(human epidermal growth factor receptor-2, HER-2)表达缺失,是乳腺癌中最具侵袭力的亚型。研究者已普遍认同“三阴”只是TNBC复杂异质性的一个共性,其本身亦存在不同亚型,并且不同亚型在临床特征方面明显不同,但对于其分类暂无统一标准[2-3]。TNBC从乳腺癌的传统治疗方法中获益有限,预后很差。本研究对210例TNBC病人的病例资料进行回顾性分析,为TNBC的进一步研究提供参考。
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观察组肿瘤长径大于对照组,发病年龄低于对照组,差异有统计学意义(P<0.05)。2组在淋巴结状态、发病部位、乳腺癌家族史上和月经状态方面差异均无统计学意义(P>0.05)(见表 1)。
项目 观察组(n=210) 对照组(n=70) χ2 P 肿瘤长径/cm <2 22(10.48) 12(14.14) 6.33 <0.05 2~5 111(52.86) 43(61.43) >5 77(36.67) 15(21.43) 淋巴结状态 阴性
阳性100(47.62)
110(52.38)38(54.29)
32(45.71)0.93 >0.05 肿瘤部位 外上象限 153(72.86) 52(74.29) 3.98 >0.05 外下象限 18(8.57) 9(12.86) 内上象限 18(8.57) 2(2.86) 内下象限 5(2.38) 2(2.86) 乳晕区 16(7.62) 5(7.14) 年龄/岁 <50
≥50136(64.76)
74(35.24)36(51.43)
34(48.57)3.94 <0.05 家族史 无
有201(95.71)
9(4.29)68(97.14)
2(2.86)0.28 >0.05 月经状态 未绝经
已绝经135(64.29)
75(35.71)38(54.29)
32(45.71)2.22 >0.05 表 1 临床特征比较[n; 构成比(%)]
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观察组210例TNBC病人中,淋巴结阳性组肿瘤长径大于淋巴结阴性组(P<0.01)(见表 2)。
分组 n T1 T2 T3 平均秩和 淋巴结阳性 110 9 51 50 116.02 淋巴结阴性 100 14 60 26 93.93 uc — — — — 2.94 P — — — — <0.01 表 2 观察组肿瘤大小与淋巴结转移的关系
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观察组超声检查Ⅳ~Ⅴ级共178例,诊断相符率84.76%(178/210)。钼靶检查Ⅳ~Ⅴ级共147例,诊断相符率70.00%(147/210)。联合检查(超声+钼靶)中任一结果为Ⅳ~Ⅴ级共199例,诊断相符率94.76%(199/210)。三种检查相符率差异有统计学意义(χ2=46.57, P<0.01), 联合检查相符率最高(P<0.01),超声次之(P<0.01),钼靶最低(P<0.01)。
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观察组中病理类型分布与对照组差异无明显统计学意义(P>0.05),病理组织学分级高于对照组(P<0.01)(见表 3)。
项目 观察组(n=210) 对照组(n=70) χ2 P 病理类型 浸润性导管癌 186(88.57) 61(87.14) 1.83 >0.05 浸润性小叶癌 7(3.33) 2(2.86) 髓样癌 3(1.43) 0(0.00) 其他 14(6.67) 7(10.00) 病理组织学分级 Ⅰ级 34(16.19) 20(28.57) 3.52* <0.01 Ⅱ级 69(32.86) 31(44.29) Ⅲ级 107(50.95) 19(27.14) 平均秩和 149.61 113.17 *示uc值 表 3 病理特征比较[n; 百分率(%)]
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随访结果表明,观察组复发率42.38%,高于对照组的28.57%(P<0.05),观察组生存率74.29%,低于对照组的85.71%(P<0.05)(见表 4)。
项目 观察组(n=210) 对照组(n=70) χ2 P 复发部位 腋窝 25(11.90) 10(14.29) 2.24 <0.05 对侧乳腺 12(5.71) 5(7.14) 其他部位 52(24.76) 5(7.14) 生存状况 存活 156(74.29) 60(85.71) 3.89 <0.05 表 4 预后比较[n; 百分率(%)]
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TNBC肿瘤长径越大,生存率越低(P<0.01)。淋巴结阴性者存活率86.00%,高于淋巴结阳性者存活率的65.45%(P<0.01)。低年龄(<50岁)和高年龄(≥50岁)病人存活率分别为76.52%和73.08%,差异无统计学意义(P>0.05)(见表 5)。
项目 存活 死亡 χ2 P 肿瘤长径/cm <2 20(86.96) 3(13.04) 12.01 <0.01 2~5 92(82.88) 19(17.12) >5 46(60.53) 30(39.47) 淋巴结状态 阴性
阳性86(86.00)
72(65.45)14(14.00)
38(34.54)11.87 <0.01 年龄/岁 <50
≥50101(76.52)
57(73.08)31(23.48)
21(26.92)0.31 >0.05 表 5 观察组预后危险因素的分析[n;百分率(%)]
三阴性乳腺癌210例临床分析
The clinical analysis of 210 cases of triple-negative breast cancer
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摘要:
目的探讨三阴性乳腺癌(triple-negative breast cancer,TNBC)病人的临床病理特征、预后及其影响因素。 方法收集2010年9月至2015年9月收治的TNBC病人210例,并选取同期治疗的非TNBC病人70例作为对照,对其临床资料进行回顾性分析。 结果肿瘤大小与淋巴结转移有关,肿瘤长径越大,淋巴结转移率越高(P < 0.01)。超声及钼靶检查对TNBC病理诊断的相符率比较,联合诊断相符率94.76%最高(P < 0.01),超声诊断相符率84.76%次之(P < 0.01),钼靶诊断相符率70.00%最低(P < 0.01)。观察组病理组织学分级高于对照组(P < 0.01)。预后分析表明,观察组复发率42.38%高于对照组28.57%,观察组生存率74.29%低于对照组85.71%(P < 0.05)。肿瘤长径越大,生存率越低(P < 0.01)。淋巴结阴性者存活率86.00%,高于淋巴结阳性者存活率65.45%(P < 0.01)。 结论与非TNBC相比,TNBC肿瘤长径大、发病年龄低、病理组织学分级高,更易复发和转移,预后更差。超声和钼靶是TNBC辅助诊断的有效检查,二者联合诊断符合率更高。肿瘤长径较大和淋巴结阳性是TNBC死亡的危险因素。 Abstract:ObjectiveTo investigate the clinicopathologic characteristics, prognosis and its risk factors of triple-negative breast cancer(TNBC). MethodsThe clinical data of 210 patients with TNBC(observation group) and 70 non-TNBC patients(control group) from September 2010 to September 2015 were retrospectively analyzed. ResultsThe lymph node metastasis rate was related to the tumor size, and the larger the tumor size, the higher the lymph node metastasis rate was(P < 0.01).Compared with the coincidence rate of pathological diagnosis of ultrasound or mammography, the coincidence rate of combined diagnosis was the highest(97.46%)(P < 0.01), and the coincidence rates of ultrasound and mammography were 84.76% and 70.0%, respectively(P < 0.01).The pathological histological classification in observation group was higher than that in control group(P < 0.01).Prognostic analysis showed that the recurrence rate and survival rate in observation group(42.38%, 74.29%) were higher and lower than those in control group(28.57%, 85.71%) respectively(P < 0.05).The larger the tumor size, the higher the lymph node metastasis rate was(P < 0.01).The survival rate in patients with negative lymph node(86.00%) was higher than that in patients with positive lymph node(65.45%)(P < 0.01). ConclusionsCompared with the non-TNBC, the tumor size is large, the age of patient is young, the pathological histological classification is high, the relapse and metastasis are ease, and the prognosis is poor in TNBC.Ultrasonography and mammography are the effective methods in auxiliary diagnosis of TNBC, and the correct rate of combination of both methods is higher.Larger tumor size and lymph node metastasis are the risk factors of TNBC death. -
Key words:
- breast neoplasms /
- clinicopathological feature /
- prognosis /
- risk factor
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表 1 临床特征比较[n; 构成比(%)]
项目 观察组(n=210) 对照组(n=70) χ2 P 肿瘤长径/cm <2 22(10.48) 12(14.14) 6.33 <0.05 2~5 111(52.86) 43(61.43) >5 77(36.67) 15(21.43) 淋巴结状态 阴性
阳性100(47.62)
110(52.38)38(54.29)
32(45.71)0.93 >0.05 肿瘤部位 外上象限 153(72.86) 52(74.29) 3.98 >0.05 外下象限 18(8.57) 9(12.86) 内上象限 18(8.57) 2(2.86) 内下象限 5(2.38) 2(2.86) 乳晕区 16(7.62) 5(7.14) 年龄/岁 <50
≥50136(64.76)
74(35.24)36(51.43)
34(48.57)3.94 <0.05 家族史 无
有201(95.71)
9(4.29)68(97.14)
2(2.86)0.28 >0.05 月经状态 未绝经
已绝经135(64.29)
75(35.71)38(54.29)
32(45.71)2.22 >0.05 表 2 观察组肿瘤大小与淋巴结转移的关系
分组 n T1 T2 T3 平均秩和 淋巴结阳性 110 9 51 50 116.02 淋巴结阴性 100 14 60 26 93.93 uc — — — — 2.94 P — — — — <0.01 表 3 病理特征比较[n; 百分率(%)]
项目 观察组(n=210) 对照组(n=70) χ2 P 病理类型 浸润性导管癌 186(88.57) 61(87.14) 1.83 >0.05 浸润性小叶癌 7(3.33) 2(2.86) 髓样癌 3(1.43) 0(0.00) 其他 14(6.67) 7(10.00) 病理组织学分级 Ⅰ级 34(16.19) 20(28.57) 3.52* <0.01 Ⅱ级 69(32.86) 31(44.29) Ⅲ级 107(50.95) 19(27.14) 平均秩和 149.61 113.17 *示uc值 表 4 预后比较[n; 百分率(%)]
项目 观察组(n=210) 对照组(n=70) χ2 P 复发部位 腋窝 25(11.90) 10(14.29) 2.24 <0.05 对侧乳腺 12(5.71) 5(7.14) 其他部位 52(24.76) 5(7.14) 生存状况 存活 156(74.29) 60(85.71) 3.89 <0.05 表 5 观察组预后危险因素的分析[n;百分率(%)]
项目 存活 死亡 χ2 P 肿瘤长径/cm <2 20(86.96) 3(13.04) 12.01 <0.01 2~5 92(82.88) 19(17.12) >5 46(60.53) 30(39.47) 淋巴结状态 阴性
阳性86(86.00)
72(65.45)14(14.00)
38(34.54)11.87 <0.01 年龄/岁 <50
≥50101(76.52)
57(73.08)31(23.48)
21(26.92)0.31 >0.05 -
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