ⅠA期乳腺癌临床病理特征、中医证型及预后相关因素分析

Analysis of clinicopathological characteristics and syndromes of traditional Chinese medicine and prognostic factors in breast cancer patients of stageⅠA

关键词:  乳腺肿瘤  小肿瘤  临床病理特征  辨证分型  预后

Key words:  breast neoplasms  small tumor  clinicopathological characteristics  syndrome differentiation  prognosis

摘要:

[目的] 探讨156例ⅠA期乳腺癌患者的临床病理特征、中医证型、治疗与预后的关系。[方法] 收集2004年1月-2009年12月天津医科大学肿瘤医院收治的156例早期乳腺癌（T₁N₀M₀,ⅠA期）的临床病理资料进行回顾性分析。[结果] 患者病理类型以浸润性导管癌为主；中医辨证临床可分为肝气郁结证、冲任失调证、燥毒蕴结证及气血双亏兼邪毒内陷证4型，以肝气郁结证为主；原发肿瘤大小以T_1c居多；组织学分级以Ⅱ级及Ⅲ级为主。5 a PFS为93.3%,5 a OS为99.1%.单因素分析结果显示，组织学分级、Ki-67表达及淋巴脉管侵犯与患者的PFS相关；多因素分析显示，组织学分级及Ki-67表达情况是影响ⅠA期（T₁N₀M₀）乳腺癌患者PFS的独立预后因素。[结论] ⅠA期（T₁N₀M₀）乳腺癌患者虽然总体预后较好，但某些亚组患者预后较差，存在明显的复发转移风险。

Abstract:

[Objective] To investigate the relationship between clinicopathological characteristics, syndromes of traditional Chinese medicine (TCM), treatment and prognosis of 156 patients with breast cancer in stage IA. [Methods] Clinical and pathological data of 156 cases of early breast cancer (T₁N₀M₀, I A) were collected and retrospectively analyzed from January 2004 to December 2009 in Tianjin Medical University Cancer Hospital. [Results] Infiltrate ductal carcinoma was the most common pathologic type; Syndrome differentiation of TCM can be divided into syndrome of stagnation of liver qi, disharmony syndrome, dryness toxin accumulation syndrome and Qi and blood deficiency and toxin depression syndrome type. Syndrome of stagnation of liver Qi was the most syndrome type; T_1c was the most primary tumor size; Grade II and Grade III were the most histological grades. 5 year PFS was 93.3% and 5 year OS was 99.1%. PFS was related to histological grade and Ki-67 expression and lymphvascular invasion in univariate analysis; Multivariate analysis showed that histological grade and Ki-67 expression were independent prognostic factors for PFS in breast cancer patients with stage I A (T₁N₀M₀). [Conclusion] Although the overall prognosis of breast cancer patients with stage I A (T₁N₀M₀) is better, there was a significant risk of recurrence and metastases in patients in some subgroups who had a poor prognosis.