北京地区一项单中心乳腺癌主要流行病学指标演变趋势的研究（2000-2015年）
发布时间：2018-08-21 20:00
【摘要】：目的近十几年来我国居民的癌症发病率总体呈现上升趋势。其中,乳腺癌是我国女性最主要的恶性肿瘤之一,发病率位居首位,死亡率仅次于肺癌、结直肠癌、胃癌,位居第四位,严重危害我国女性的生命健康。乳腺癌的发病具有城乡差别,城市地区乳腺癌发病率较高,农村地区乳腺癌死亡率较高[1,2]。国内已有不少关于乳腺癌流行病学的相关报道[3-5],但乳腺癌的流行病学特征,如发病年龄分布、临床分期等,可能随着时间的改变、筛查的逐步开展以及诊断技术的提高等因素而发生改变。针对我国乳腺癌流行病学随时间的动态演变趋势的研究极少,缺乏相关的大样本数据。本研究旨在分析2000.01.01~2015.12.31期间,初治且在我院手术的原发性女性乳腺癌的主要流行病学特征(发病年龄、临床分期和分子分型)的变化趋势,为乳腺癌的预防、筛查提供更为科学的依据。方法从军事医学科学院附属医院(解放军307医院)病案室电子病例档案库中,收集2000.01.01~2015.12.31期间,初治且在我院手术的原发性女性乳腺癌患者资料2482例。组织学分类参照2003年世界卫生组织(World Health Organization,WHO)乳腺肿瘤组织学分类;TNM分期参照2010年美国癌症联合委员会(American Joint Committee on Cancer,AJCC)乳腺癌TNM分期[6];分子分型参照2013年ST Gallen共识,分为Luminal型(Luminal A型+Luminal B型)、三阴型、HER2过表达型。运用Excel 2013进行乳腺癌相关数据录入和图表绘制,建立数据库,回顾性分析乳腺癌患者发病年龄、临床分期和分子分型的总体分布特征及其随年代变化的趋势。统计分析采用SAS 9.2软件。定量资料的描述采用均数±标准差、中位数(四分位数间距),不同年份的比较采用方差分析或者Kruskal-Wallis秩和检验;定性资料的描述采用率或构成比,不同年份的比较采用卡方检验或Fisher精确概率法。检验水平α=0.05。结果1.2482例符合条件的乳腺癌患者主要来自我国北方地区。2000~2015年间,我院乳腺癌确诊人数呈逐年上升趋势,其中2000~2005年302例,2006~2010年746例,2011~2015年1434例。2482例初治原发性乳腺癌中位确诊年龄48(19~87)岁,发病高峰年龄段41~60岁(占61.04%),36~65岁年龄段的乳腺癌占81.43%。其中,2000~2005年的中位年龄为48(23~85)岁,2006~2010年的中位年龄为48(19~82)岁,2011~2015年的中位年龄为49(20~87)岁,无明显变化趋势,差异无统计学意义(P=0.0679)。2.早发性乳腺癌(35岁)共193例,占总确诊人数的7.78%(193/2482)。其中2000~2005年早发性乳腺癌比率7.95%(24/302),2006~2010年早发性乳腺癌比率7.10%(53/746),2011~2015年早发性乳腺癌比率8.09%(116/1434),无明显变化趋势,差异无统计学意义(P=0.7127)。3.2482例初治原发性乳腺癌可进行组织学分类的共2446例(98.55%),其中原位癌203例(8.30%),浸润性乳腺癌2243例(91.70%)。2000~2005年原位癌比率2.43%(7/288),2006~2010年原位癌比率6.77%(50/739),2011~2015年原位癌比率10.29%(146/1419),随时间上升趋势显著,差异具有统计学意义(P0.0001)。4.2482例中可进行TNM分期的共2403例(96.81%)。其中0期乳腺癌203例,占比8.45%(203/2403);Ⅰ期乳腺癌636例,2000~2005年Ⅰ期乳腺癌比率22.30%(64/287),2006~2010年Ⅰ期乳腺癌比率23.55%(171/726),2011~2015年Ⅰ期乳腺癌比率28.83%(401/1391),上升趋势显著;Ⅱ期乳腺癌1025例,2000~2005年Ⅱ期乳腺癌比率45.30%(130/287),2006~2010年Ⅱ期乳腺癌比率47.52%(345/726),2011~2015年Ⅱ期乳腺癌比率39.54%(550/1391),有所下降;Ⅲ期乳腺癌449例,2000~2005年Ⅲ期乳腺癌比率26.83%(77/287),2006~2010年Ⅲ期乳腺癌比率18.04%(131/726),2011~2015年Ⅲ期乳腺癌比率17.33%(241/1391),比率呈下降趋势;Ⅳ期乳腺癌90例,2000~2005年Ⅳ期乳腺癌比率3.14%(9/287),2006~2010年Ⅳ期乳腺癌比率3.99%(29/726),2011~2015年Ⅳ期乳腺癌比率3.74%(52/1391),比率趋势变化平稳。整体变化差异有统计学意义(P0.0001)。5.可手术早期乳腺癌(0~Ⅱ期+T3N1M0期)共1904例,占可行TNM分期乳腺癌的79.23%(1904/2403)。其中2000~2005年可手术早期乳腺癌比率73.52%(211/287),2006~2010年可手术早期乳腺癌比率80.30%(583/726),2011~2015年可手术早期乳腺癌比率79.86%(1110/1390),随时间变化有增加趋势,差异具有统计学意义(P=0.0379)。6.2482例初治原发性乳腺癌有免疫组化四项(ER、RP、HER2、Ki-67)的共2238例(90.17%),原位癌171例,浸润性癌2067例。浸润性癌中Luminal型(包括Luminal A型和Luminal B型)比率73.73%(1524/2067),三阴型比率17.42%(360/2067),HER2过表达型比率8.85%(183/2067)。2000~2005年Luminal型比率70.19%(146/208),2006~2010年Luminal型比率72.13%(458/635),2011~2015年Luminal型比率75.16%(920/1224),随时间有上升趋势;2000~2005年HER2过表达型比率4.33%(9/208),2006~2010年HER2过表达型比率8.50%(54/635),2011~2015年HER2过表达型比率9.80%(120/1224),随时间有上升趋势;2000~2005年三阴型比率25.48%(53/208),2006~2010年三阴型比率19.37%(123/635),2011~2015年三阴型比率15.03%(184/1224),随时间有减少趋势,整体频数分布差异有统计学意义(P=0.0005)。结论1、2000~2015年,我院乳腺癌中位发病年龄近5年虽略有增加,但未发现明显上升,高峰发病年龄段为41~60岁(占比61.04%),中位年龄48岁,36~65岁年龄段的乳腺癌占所有乳腺癌的81.43%,该年龄段的女性应考虑为乳腺癌筛查的重点人群。2、早发性乳腺癌(35岁)发病总体稳定,在乳腺癌中仍有8%左右的较高比例;3、可手术早期乳腺癌(0~Ⅱ期,Ⅲ期中的T3N1M0),尤其是原位癌(0期)和Ⅰ期乳腺癌比例近年来有显著增加的趋势,而局部晚期乳腺癌有减少的趋势,Ⅳ期乳腺癌变化趋势不明显;4、浸润性乳腺癌分子分型总体随时间变化趋势不大,本研究发现Luminal型及HER2过表达型乳腺癌有增加趋势,Luminal型近5年比例达75%以上,是最主要的分子亚型。
[Abstract]:Objective In recent ten years, the incidence of cancer in Chinese residents has been on the rise. Breast cancer is one of the most important malignant tumors in Chinese women. The incidence of breast cancer ranks first, the mortality rate is second only to lung cancer, colorectal cancer, gastric cancer, ranking fourth, seriously endangering the lives and health of Chinese women. The incidence of breast cancer in urban areas is higher than that in rural areas [1,2]. There have been many reports on the epidemiology of breast cancer in China [3-5]. However, the epidemiological characteristics of breast cancer, such as age distribution and clinical stage, may be due to the change of time, the gradual development of screening and the improvement of diagnostic techniques. This study was designed to analyze the main epidemiological characteristics (age of onset, clinical stage and molecular typing) of primary female breast cancer, which was initially treated and operated on in our hospital from January 2000 to December 2015.31. Methods 2482 cases of primary female breast cancer were collected from the electronic case archives of the medical record room of the Affiliated Hospital of the Chinese Academy of Military Medical Sciences (307 Hospital of the PLA) from January 2000 to December 2015. According to the World Health Organization (WHO) histological classification of breast tumors, TNM staging refers to the 2010 American Joint Committee on Cancer (AJCC) TNM staging [6]; molecular typing refers to the 2013 ST Gallen consensus, divided into Luminal type (Luminal A + Luminal B), three negative, HER2 over-expression. Excel 2013 was used to input and draw maps of breast cancer related data. A database was established to retrospectively analyze the age of onset, clinical stages and molecular typing of breast cancer patients and their overall distribution characteristics. Quantile spacing), variance analysis or Kruskal-Wallis rank sum test were used for comparison in different years, and the descriptive rate or composition ratio of qualitative data was used for comparison in different years. Chi-square test or Fisher exact probability method were used for comparison in different years. From 2000 to 2005, 302 breast cancer cases, 746 cases from 2006 to 2010, 1434 cases from 2011 to 2015. 2482 cases of primary breast cancer were diagnosed at the median age of 48 (19-87), the peak age of onset was 41-60 (61.04%) and breast cancer at the age of 36-65 (81.43%). The median age from 2006 to 2010 was 48 (19-82). The median age from 2011 to 2015 was 49 (20-87). There was no significant difference (P = 0.0679). 2. There were 193 cases of early-onset breast cancer (35 years old), accounting for 7.78% (193/2482) of the total number of confirmed cases. The 10-year incidence of early-onset breast cancer was 7.10% (53/746) and 8.09% (116/1434) respectively. There was no significant change trend between 2011 and 2015 (P = 0.7127). In 2005, the ratio of carcinoma in situ was 2.43% (7/288), 2006-2010 was 6.77% (50/739), 2011-2015 was 10.29% (146/1419), and there was a significant upward trend with time (P 0.0001). 4.2482 cases (96.81%) had TNM staging, 203 cases (8.45%) had stage 0 breast cancer and 1 stage breast cancer. 636 cases of cancer, 2000-2005 stage I breast cancer rate 22.30% (64/287), 2006-2010 stage I breast cancer rate 23.55% (171/726), 2011-2015 stage I breast cancer rate 28.83% (401/1391), a significant upward trend; stage II breast cancer 1025 cases, 2000-2005 stage II breast cancer rate 45.30% (130/287), 2006-2010 stage II breast cancer rate 47.52% (345/726), 20. The proportion of stage II breast cancer was 39.54% (550/1391) from 11 to 2015, which decreased slightly; 449 cases of stage III breast cancer, 26.83% (77/287) of stage III breast cancer from 2000 to 2005, 18.04% (131/726) of stage III breast cancer from 2006 to 2010, 17.33% (241/1391) of stage III breast cancer from 2011 to 2015, the ratio showed a downward trend; 90 cases of stage IV breast cancer, stage IV breast cancer from 2000 to 2005. The cancer rate was 3.14% (9/287), the stage IV breast cancer rate was 3.99% (29/726) from 2006 to 2010, and the stage IV breast cancer rate was 3.74% (52/1391) from 2011 to 2015. The overall change was statistically significant (P 0.0001). The rate of operable early breast cancer was 73.52% (211/287) from 2000 to 2005, 80.30% (583/726) from 2006 to 2010, and 79.86% (1110/1390) from 2011 to 2015. The difference was statistically significant (P = 0.0379). 4 items of immunohistochemistry were found in 6.2482 cases of primary breast cancer. (ER, RP, HER2, Ki-67) in 2238 cases (90.17%), 171 cases of carcinoma in situ, 2067 cases of invasive carcinoma. The ratio of Luminal type (including Luminal A and Luminal B) in invasive carcinoma was 73.73% (1524/2067), the ratio of triple negative was 17.42% (360/2067), and the ratio of overexpression of HER2 was 8.85% (183/2067). The overexpression rate of HER2 was 4.33% (9/208) in 2000-2005, 8.50% (54/635) in 2006-2010, 9.80% (120/1224) in 2011-2015, and 25.48% (53/208) in 2000-2005. From 2006 to 2010, the tri-negative rate was 19.37% (123/635), and from 2011 to 2015, the tri-negative rate was 15.03% (184/1224). There was a decreasing trend with time. The overall frequency distribution was statistically significant (P = 0.0005). The incidence of early-onset breast cancer (35 years old) is generally stable, and there is still a high proportion of 8% in breast cancer. 3. Early-stage breast cancer (0-II, III stage T3N) can be operated on. In recent years, the proportion of 1M0 breast cancer, especially in situ (stage 0) and stage I breast cancer increased significantly, while the proportion of locally advanced breast cancer decreased, and the change trend of stage IV breast cancer was not obvious. 4. The molecular typing of invasive breast cancer did not change significantly with time. This study found that Luminal and HER2 overexpression breast cancer had an increasing trend. In the past 5 years, the proportion of Luminal is more than 75%, and is the most important molecular subtype.
【学位授予单位】：中国人民解放军军事医学科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9
本文编号：2196204
[Abstract]:Objective In recent ten years, the incidence of cancer in Chinese residents has been on the rise. Breast cancer is one of the most important malignant tumors in Chinese women. The incidence of breast cancer ranks first, the mortality rate is second only to lung cancer, colorectal cancer, gastric cancer, ranking fourth, seriously endangering the lives and health of Chinese women. The incidence of breast cancer in urban areas is higher than that in rural areas [1,2]. There have been many reports on the epidemiology of breast cancer in China [3-5]. However, the epidemiological characteristics of breast cancer, such as age distribution and clinical stage, may be due to the change of time, the gradual development of screening and the improvement of diagnostic techniques. This study was designed to analyze the main epidemiological characteristics (age of onset, clinical stage and molecular typing) of primary female breast cancer, which was initially treated and operated on in our hospital from January 2000 to December 2015.31. Methods 2482 cases of primary female breast cancer were collected from the electronic case archives of the medical record room of the Affiliated Hospital of the Chinese Academy of Military Medical Sciences (307 Hospital of the PLA) from January 2000 to December 2015. According to the World Health Organization (WHO) histological classification of breast tumors, TNM staging refers to the 2010 American Joint Committee on Cancer (AJCC) TNM staging [6]; molecular typing refers to the 2013 ST Gallen consensus, divided into Luminal type (Luminal A + Luminal B), three negative, HER2 over-expression. Excel 2013 was used to input and draw maps of breast cancer related data. A database was established to retrospectively analyze the age of onset, clinical stages and molecular typing of breast cancer patients and their overall distribution characteristics. Quantile spacing), variance analysis or Kruskal-Wallis rank sum test were used for comparison in different years, and the descriptive rate or composition ratio of qualitative data was used for comparison in different years. Chi-square test or Fisher exact probability method were used for comparison in different years. From 2000 to 2005, 302 breast cancer cases, 746 cases from 2006 to 2010, 1434 cases from 2011 to 2015. 2482 cases of primary breast cancer were diagnosed at the median age of 48 (19-87), the peak age of onset was 41-60 (61.04%) and breast cancer at the age of 36-65 (81.43%). The median age from 2006 to 2010 was 48 (19-82). The median age from 2011 to 2015 was 49 (20-87). There was no significant difference (P = 0.0679). 2. There were 193 cases of early-onset breast cancer (35 years old), accounting for 7.78% (193/2482) of the total number of confirmed cases. The 10-year incidence of early-onset breast cancer was 7.10% (53/746) and 8.09% (116/1434) respectively. There was no significant change trend between 2011 and 2015 (P = 0.7127). In 2005, the ratio of carcinoma in situ was 2.43% (7/288), 2006-2010 was 6.77% (50/739), 2011-2015 was 10.29% (146/1419), and there was a significant upward trend with time (P 0.0001). 4.2482 cases (96.81%) had TNM staging, 203 cases (8.45%) had stage 0 breast cancer and 1 stage breast cancer. 636 cases of cancer, 2000-2005 stage I breast cancer rate 22.30% (64/287), 2006-2010 stage I breast cancer rate 23.55% (171/726), 2011-2015 stage I breast cancer rate 28.83% (401/1391), a significant upward trend; stage II breast cancer 1025 cases, 2000-2005 stage II breast cancer rate 45.30% (130/287), 2006-2010 stage II breast cancer rate 47.52% (345/726), 20. The proportion of stage II breast cancer was 39.54% (550/1391) from 11 to 2015, which decreased slightly; 449 cases of stage III breast cancer, 26.83% (77/287) of stage III breast cancer from 2000 to 2005, 18.04% (131/726) of stage III breast cancer from 2006 to 2010, 17.33% (241/1391) of stage III breast cancer from 2011 to 2015, the ratio showed a downward trend; 90 cases of stage IV breast cancer, stage IV breast cancer from 2000 to 2005. The cancer rate was 3.14% (9/287), the stage IV breast cancer rate was 3.99% (29/726) from 2006 to 2010, and the stage IV breast cancer rate was 3.74% (52/1391) from 2011 to 2015. The overall change was statistically significant (P 0.0001). The rate of operable early breast cancer was 73.52% (211/287) from 2000 to 2005, 80.30% (583/726) from 2006 to 2010, and 79.86% (1110/1390) from 2011 to 2015. The difference was statistically significant (P = 0.0379). 4 items of immunohistochemistry were found in 6.2482 cases of primary breast cancer. (ER, RP, HER2, Ki-67) in 2238 cases (90.17%), 171 cases of carcinoma in situ, 2067 cases of invasive carcinoma. The ratio of Luminal type (including Luminal A and Luminal B) in invasive carcinoma was 73.73% (1524/2067), the ratio of triple negative was 17.42% (360/2067), and the ratio of overexpression of HER2 was 8.85% (183/2067). The overexpression rate of HER2 was 4.33% (9/208) in 2000-2005, 8.50% (54/635) in 2006-2010, 9.80% (120/1224) in 2011-2015, and 25.48% (53/208) in 2000-2005. From 2006 to 2010, the tri-negative rate was 19.37% (123/635), and from 2011 to 2015, the tri-negative rate was 15.03% (184/1224). There was a decreasing trend with time. The overall frequency distribution was statistically significant (P = 0.0005). The incidence of early-onset breast cancer (35 years old) is generally stable, and there is still a high proportion of 8% in breast cancer. 3. Early-stage breast cancer (0-II, III stage T3N) can be operated on. In recent years, the proportion of 1M0 breast cancer, especially in situ (stage 0) and stage I breast cancer increased significantly, while the proportion of locally advanced breast cancer decreased, and the change trend of stage IV breast cancer was not obvious. 4. The molecular typing of invasive breast cancer did not change significantly with time. This study found that Luminal and HER2 overexpression breast cancer had an increasing trend. In the past 5 years, the proportion of Luminal is more than 75%, and is the most important molecular subtype.
【学位授予单位】：中国人民解放军军事医学科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9
【参考文献】
相关期刊论文 前10条
1 陈万青;郑荣寿;张思维;曾红梅;邹小农;赫捷;;2013年中国恶性肿瘤发病和死亡分析[J];中国肿瘤;2017年01期
2 白焕焕;;青年乳腺癌患者的病理特征及预后的相关影响因素分析[J];实用癌症杂志;2016年10期
3 王立锋;许雪青;;2016年《NCCN遗传性/家族性高风险评估指南:乳腺和卵巢》介绍[J];中华乳腺病杂志(电子版);2016年05期
4 张保宁;;国际乳腺癌筛查指南的争议引发的思考[J];癌症进展;2016年02期
5 高国璇;于大鹏;张虹;张爽;徐玲;叶京明;李挺;段学宁;刘荫华;;青年女性乳腺癌临床病理学特点及预后相关因素分析[J];中国实用外科杂志;2016年01期
6 张建霞;;彩色多普勒超声检查诊断早发性乳腺癌的临床应用价值[J];中国实用医药;2015年30期
7 毛莉;刘涛;王定明;宋沈超;陈敏;余志强;;2013年贵州省女性乳腺疾病筛查结果分析[J];中华疾病控制杂志;2015年07期
8 陈万青;郑荣寿;;中国女性乳腺癌发病死亡和生存状况[J];中国肿瘤临床;2015年13期
9 令狐锐霞;司文;李莹;杨俊兰;;3846例乳腺癌流行病学及临床病理学分析[J];解放军医学院学报;2015年10期
10 吴旦平;张红丹;符炜;汪波;商江峰;宋佳;;乳腺癌筛查在我国农村妇女早期乳腺癌诊断中的作用及知信行现状分析[J];中国医药导报;2015年17期
，本文编号：2196204
本文链接：https://www.wllwen.com/yixuelunwen/zlx/2196204.html
