放疗延迟对乳腺癌不同分子亚型患者预后的影响

doi:10.11904/j.issn.1002-3070.2019.05.009

摘要/Abstract

摘要： 目的探讨放疗延迟对乳腺癌不同分子亚型患者预后的影响。方法收集2007年1月—2012年12月在我院行乳腺癌根治术患者341例,其中Luminal A型149例(对照组83例,放疗延迟组66例),Luminal B型105例(对照组63例,放疗延迟组42例),HER2+型43例(对照组28例,放疗延迟组15例),三阴型患者44例(对照组27例,放疗延迟组17例)分析放疗延迟组与对照组预后是否存在差异。结果 Luminal A型、Luminal B型、HER2+型、三阴性型在对照组和放疗延迟组的局部复发率分别为(4.8% vs. 9.1%,P=0.301),(4.7% vs. 19.0%,P=0.019),(7.1% vs. 33.3%,P=0.027),(11.1% vs. 35.3%,P=0.053);远处转移率分别为(9.6% vs. 10.6%,P=0.845),(11.1% vs. 14.2%.P=0.234),(32.1% vs. 40.0%,P=0.937),(37.0% vs. 41.2%,P=0.784);无瘤生存率分别为(85.5% vs. 80.3%,P=0.395),(84.1% vs. 66.7%,P=0.037),(60.7% vs. 33.3%,P=0.087),(55.5% vs. 23.5%,P=0.037);总生存率分别为(94.0% vs. 90.9%,P=0.539),(84.1% vs. 80.9%,P=0.672),(67.9% vs. 60.0%,P=0.606),(59.2% vs. 41.2%,P=0.242)。Cox回归分析结果显示肿瘤大小(HR=3.156,P=0.043)、淋巴结转移(HR=1.074,P=0.001)、TNM(HR=8.591,P=0.009)和分子亚型(HR=2.092,P＜0.001)为乳腺癌患者预后的独立影响因素。结论 Luminal B型及HER2+型患者的局部复发率均因放疗延迟而明显增高,Luminal B型及三阴型的无瘤生存率因放疗延迟而明显降低。肿瘤大小、淋巴结转移、TNM分期和分子亚型是影响患者总生存期的独立危险因素。

关键词: 乳腺癌, 放射治疗, 分子分型

Abstract: Objective The aim of this study was to investigate the effect of delayed radiotherapy on the prognosis of breast cancer patients with different molecular subtypes.Methods A total of 341 patients with radical mastectomy were enrolled in our hospital from January 2007 to December 2012.There were 149 patients with Luminal A type,83 patients in the control group,and 66 patients in the delayed radiotherapy group.There were 105 cases with Luminal B type,63 cases of control group and 42 cases of delayed radiotherapy.There were 43 cases of HER2+,28 cases of control group and 15 cases of delayed radiotherapy.There were 44 patients with triple-negative,27 cases in the control group,and 17 patients in the delayed radiotherapy group.Analyzed the difference in progposis betueen the delayed radiotherapy group and the contrel group.Results The local recurrence rate of Luminal A,Luminal B,HER2+ and triple negative type in the control group and the delayed radiotherapy group were(4.8% vs. 9.1%,P=0.301),(4.7% vs. 19.0%,P=0.019),(7.1% vs. 33.3%,P=0.027),(11.1% vs. 35.3%,P=0.053),respectively;distant metastasis rate:(9.6% vs. 10.6%,P=0.8 45),(11.1% vs. 14.2%,P=0.234),(32.1% vs. 40.0%,P=0.937),(37.0% vs. 41.2%,P=0.784),respectively;tumor-free survival rate:(85.5% vs. 80.3%,P=0.395),(84.1% vs. 66.7%,P=0.037),(60.7% vs. 33.3%,P=0.087),(55.5% vs. 23.5%,P=0.037),respectively;overall survival rate:(94.0% vs. 90.9%,P=0.539),(84.1% vs. 80.9%,P=0.672),(67.9% vs. 60.0%,P=0.606),(59.2% vs. 41.2%,P=0.242),respectively.Cox regression analysis showed that tumor size(HR=3.156,P=0.043),lymph node metastasis(HR=1.074,P=0.001),TNM(HR=8.591,P=0.009)and molecular subtype(HR=2.092,P＜0.001)were independent factors influencing prognosis of breast cancer patients.Conclusion The local recurrence rate of Luminal B type and HER2+ is significantly increased due to delayed radiotherapy.The disease-free survival rates of Luminal B type and triple negative type are significantly increased reduced due to delayed radiotherapy.Tumor size,lymph node metastasis,TNM staging and molecular subtypes are independent risk factors for patient survival.

Key words: Breast cancer, Radio therapy, Molecular typing

中图分类号:

R737.9

师镘茹, 鄂明艳. 放疗延迟对乳腺癌不同分子亚型患者预后的影响[J]. 实用肿瘤学杂志, 2019, 33(5): 431-435.

SHI Manru, E Mingyan. Effect of delayed radiotherapy on the prognosis of patients with different molecular subtypes of breast cancer[J]. Journal of Practical Oncology, 2019, 33(5): 431-435.

0
/ / 推荐

导出引用管理器 EndNote|Reference Manager|ProCite|BibTeX|RefWorks

链接本文: http://journal09.magtechjournal.com/Jwk3_syzlxzz/CN/10.11904/j.issn.1002-3070.2019.05.009

http://journal09.magtechjournal.com/Jwk3_syzlxzz/CN/Y2019/V33/I5/431

参考文献

1 Ferlay J,Soerjomataram I,Dikshit R.Cancer incidence and mortality worldwide:Sources,methods and major patterns in GLOBOCAN 2012[J].Int J Cancer,2015,136(5):359-386.
2 Perou CM,Sorlie T,Eisen MB.Molecular portraits of human breast tumours[J].Nature,2000,406(6797):747-752.
3 Sorlie T,Perou CM,Tibshirani R.Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications[J].Proc Natl Acad Sci U S A,2001,98(19):10869-10874.
4 Cheang MCU,Chia SK,David V.Ki67 index,HER-2 status,and prognosis of patients with luminal B breast cancer[J].J Nat Cancer Inst,2009,101(10):731-750.
5 Otto MF,Zhouxin S,Giuseppe V.Patterns of recurrence and outcome according to breast cancer subtypes in lymph node-negative disease:results from international breast cancer study group trials VIII and IX[J].J Clin Oncol,2013,31(25):3083-3090.
6 Gao JJ,Swain SM.Luminal A breast cancer and molecular assays:a review[J].Oncologist,2018,23(5):556-565.
7 Qiu J,Xue X,Hu C.Comparison of clinicopathological features and prognosis in triple-negative and non-triple negative breast cancer[J].J Cancer,2016,7(2):167-173.
8 Telli ML,Chang ET,Kurian AW.Asian ethnicity and breast cancer subtypes:a study from the California cancer registry[J].Breast Cancer Res Treat,2011,127(2):471-478.
9 李嘉琪,栾瑾微,张玉,等.763例三阴性乳腺癌临床病理特征及复发、转移影响因素分析[J].实用肿瘤学杂志,2019,33(3):244-249.
10 Li X,Yang J,Peng L.Triple-negative breast cancer has worse overall survival and cause-specific survival than non-triple-negative breast cancer[J].Breast Cancer Res Treat,2017,161(2):279-287.
11 Wu Q,Li J,Zhu S.Breast cancer subtypes predict the preferential site of distant metastases:a SEER based study[J].Oncotarget,2017,8(17):27990-27996.
12 Fei-Fei L,Wei S,Done SJ.Identification of low-risk luminal a breast cancer cohort that may not benefit from breast radiotherapy[J].J Clin Oncol,2015,33(18):2035-2040.
13 Gallardo A,Garcia-Valdecasas B,Murata P.Inverse relationship between Ki67 and survival in early luminal breast cancer:confirmation in a multivariate analysis[J].Breast Cancer Res Treat,2018,167(1):31-37.
14 Recht A,Come SE,Henderson IC.The sequencing of chemotherapy and radiation therapy after conservative surgery for early-stage breast cancer[J].N Engl J Med,1996,334:1356.
15 Buchholz TA,Austin-Seymour MM,Moe RE,et al.Effect of delay in radiation in the combined modality treatment of breast cancer[J].Int Radiat Oncol Biol Phys,1993,26(1):23-35.

[1]	李磊 , 张清媛. 乳腺癌抗肿瘤血管治疗的临床进展[J]. 实用肿瘤学杂志, 2019, 33(5): 461-465.
[2]	王宇, 乔娟娟, 张磊, 刘四卫 , 杨树才. 类固醇激素在乳腺癌中的作用及对肿瘤干细胞的影响[J]. 实用肿瘤学杂志, 2019, 33(5): 466-470.
[3]	刘尔钰, 杨昊, 梁国华, 赵晏方, 赵文辉. CDK4/6抑制剂联合mTOR抑制剂在乳腺癌中的作用机制[J]. 实用肿瘤学杂志, 2019, 33(5): 476-480.
[4]	安巍巍, 唐雅莉, 赵莲花, 杨悦, 王新玲. 红松松塔提取物多聚苯丙素-多糖复合物诱导人乳腺癌MCF-7细胞凋亡[J]. 实用肿瘤学杂志, 2019, 33(4): 289-293.
[5]	胡琳, 沈佳. GDF-15在预测和监控表柔比星/环磷酰胺-多西他赛-曲妥珠单抗辅助治疗HER-2阳性乳腺癌患者产生心脏毒性中的作用[J]. 实用肿瘤学杂志, 2019, 33(4): 340-345.
[6]	马焱, 何红, 王赛男. 多西他赛解救治疗不同年龄组转移性乳腺癌的临床研究[J]. 实用肿瘤学杂志, 2019, 33(4): 352-356.
[7]	陈宏博, 余增荣, 丁小凡肖林. 盆腔肿瘤IMRT下骨髓剂量-体积参数与急性血液学毒性相关性研究进展[J]. 实用肿瘤学杂志, 2019, 33(4): 361-366.
[8]	王晓雅,肖斌,廖扬,唐荣芝,孙朝晖,李林海. CXCR家族蛋白在不同乳腺癌亚型中的表达及临床预后分析[J]. 实用肿瘤学杂志, 2019, 33(3): 206-210.
[9]	李烁,张楠楠,李亮亮,龙志平,尹慧慧,赵亚双,王帆. 外周血白细胞PDE4C基因甲基化及环境因素交互作用与乳腺癌发病的关系[J]. 实用肿瘤学杂志, 2019, 33(3): 233-238.
[10]	李嘉琪,栾瑾微,张,玉,李香兰. 763例三阴性乳腺癌临床病理特征及复发、转移影响因素分析[J]. 实用肿瘤学杂志, 2019, 33(3): 244-249.
[11]	李珊,赵春波,乔文波. 术中放疗在胰腺癌中的应用进展[J]. 实用肿瘤学杂志, 2019, 33(3): 280-283.
[12]	陈艳波, 孔德嘉, 张金锋, 马志刚. 乳腺癌患者CYP2D6基因多态性与他莫昔芬代谢相关性研究[J]. 实用肿瘤学杂志, 2019, 33(2): 110-114.
[13]	孙江宏, 郝明珠, 姜丹, 国飞, 李晓梅. 乳腺炎、良性增生及乳腺癌FFDM鉴别诊断思路[J]. 实用肿瘤学杂志, 2019, 33(2): 139-141.
[14]	马志杰, 王帆, 赵亚双. 乳腺癌化疗患者生存质量及影响因素分析[J]. 实用肿瘤学杂志, 2019, 33(2): 149-154.
[15]	马质莹, 尚乃舰, 蔡妙田, 沈阳, 姜智允. 孕激素及雌激素受体阳性乳腺癌HER-2受体与钼靶影像学特征及临床病理学特征的相关性分析[J]. 实用肿瘤学杂志, 2019, 33(1): 47-51.