老年女性乳腺癌的临床病理特征及预后分析

发布时间：2018-06-14 10:43

本文选题：乳腺癌 + 老年女性　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:总结和分析老年女性乳腺癌患者的临床病理特征、治疗方式及预后等,并与国内外相关研究结果进行对比研究,同时探讨影响老年女性乳腺癌患者预后的因素,为老年女性乳腺癌的规范化和个体化治疗提供理论依据。方法:1回顾性分析自2009年1月至2015年12月河北省乳腺中心收治的1144例老年女性(年龄"g65)原发性乳腺癌患者的临床病理资料,并分为65-70岁及70岁以上年龄组进行临床病理特征、治疗现状及预后等方面的对比分析;对从2009年1月至2011年12月收治的382例原发性老年乳腺癌患者进行随访,应用总生存率(OS)及无病生存率(DFS)进行预后评价,分析影响老年女性乳腺癌患者的预后因素。2应用SPSS21.0统计软件进行数据分析。不同年龄组患者间的一般资料、临床病理特征、分子生物学指标及治疗方式等的比较采用χ2检验或Fisher确切概率法;应用Kaplan-Meier法进行单因素生存分析,组间比较采用Log-rank检验,多因素分析采用Cox风险比例模型。以P0.05为差异具有统计学意义。结果:1老年女性乳腺癌患者绝大多数(94.2%)是以乳房肿物为首发症状。浸润性导管癌是老年女性乳腺癌患者最常见的病理类型,预后较好的病理类型浸润性小叶癌、粘液腺癌在高龄组患者的比例相对偏高。老年乳腺癌患者就诊时肿瘤直径偏大,疾病分期以T1-2期为主,腋窝淋巴结转移阳性率为37.8%,且以1-3个淋巴结转移多见。老年乳腺癌患者具有较好的分子生物学指标:ER阳性率为71.9%,PR阳性率63.3%,Ki-67高表达及HER-2阳性比例低,肿瘤分化级别低。2手术治疗是老年乳腺癌患者的主要治疗方式,改良根治术为最常见的术式(78.7%),保乳手术比例相对年轻人及西方数据偏低。术后辅助治疗中,化疗及放疗比例均相对偏低,内分泌治疗是术后辅助治疗的主要手段之一,共773例(67.6%)患者接受内分泌治疗。3在382例完整随访患者中,中位随访时间是64个月,5年总生存率OS为86.6%,其中64例患者出现死亡,41例死于乳腺癌。5年的无病生存率DFS是83.2%,74例患者出现远处转移或局部复发。单因素及多因素分析显示年龄和肿瘤直径是影响老年乳腺癌患者OS的独立预后因素,影响DFS的独立预后因素是肿瘤直径。结论:老年乳腺癌患者相对于青年人群具有更好的病理学特征及分子生物学指标,治疗方式上手术治疗及术后辅助内分泌治疗更常见,辅助化疗及放疗比例明显偏低,年龄和肿瘤直径是影响老年女性乳腺癌患者OS的独立预后因素,70岁以下组患者的5年OS优于70岁以上组患者。
[Abstract]:Objective: to summarize and analyze the clinicopathological features, treatment methods and prognosis of elderly women with breast cancer, and to compare the results with those of other related studies at home and abroad, and to explore the factors influencing the prognosis of elderly women with breast cancer. To provide theoretical basis for standardization and individualized treatment of breast cancer in elderly women. Methods from January 2009 to December 2015, the clinicopathological data of 1144 elderly women (g65) with primary breast cancer were retrospectively analyzed and divided into the age group of 65 to 70 years old and the age group over 70 years old. From January 2009 to December 2011, 382 cases of primary elderly breast cancer were followed up, and the overall survival rate (OS) and disease-free survival rate (DFS) were evaluated. The prognostic factors of elderly women with breast cancer were analyzed by SPSS 21.0 statistical software. The general data, clinicopathological features, molecular biological parameters and treatment methods were compared by 蠂 2 test or Fisher exact probability method, Kaplan-Meier method was used for univariate survival analysis, and Log-rank test was used for the comparison between groups. Cox risk proportional model was used for multivariate analysis. P0.05 as the difference was statistically significant. Results the breast mass was the first symptom in the majority of female breast cancer patients. Invasive ductal carcinoma is the most common pathological type in elderly women with breast cancer. The prognosis of invasive lobular carcinoma is better. The proportion of mucinous adenocarcinoma in the elderly patients is relatively high. The tumor diameter was larger in the elderly patients with breast cancer. The stage of the disease was mainly T1-2. The positive rate of axillary lymph node metastasis was 37.8 and 1-3 lymph node metastases were more common. The positive rate of 71.9% PR and 63.3% Ki-67 and HER-2 positive rate were 63.3% and 63.3% respectively in the elderly patients with breast cancer. The low differentiation grade of tumor was the main treatment method for the elderly breast cancer patients. Modified radical mastectomy was the most common operation, and the proportion of breast conserving surgery was lower than that of young people and western countries. In postoperative adjuvant therapy, the proportion of chemotherapy and radiotherapy was relatively low. Endocrine therapy was one of the main methods of postoperative adjuvant therapy. The median follow-up time was 64 months, and the overall 5-year survival rate was 86.6%. Among them, 41 cases died of breast cancer in 64 cases, and the 5-year disease-free survival rate (DFS) was 83.22.74 cases with distant metastasis or local recurrence. Univariate and multivariate analysis showed that age and tumor diameter were independent prognostic factors of OS in elderly patients with breast cancer, and tumor diameter was the independent prognostic factor of DFS. Conclusion: elderly patients with breast cancer have better pathological characteristics and molecular biological indexes than young people. Surgical treatment and postoperative adjuvant endocrine therapy are more common than young people, and the proportion of adjuvant chemotherapy and radiotherapy is obviously low. Age and tumor diameter were independent prognostic factors of OS in elderly women with breast cancer. The 5-year OS of patients under 70 years old was better than that of patients over 70 years old.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

【参考文献】