不同分子分型青年乳腺癌的臨床特點及預后因素分析

艾勇彪 袁杰 李文仿

[摘要] 目的 探討35歲及以下不同分子分型乳腺癌患者的臨床病理特點與預后差異，并分析影響預后因素。方法 回顧性分析2007年2月～2014年1月湖北省十堰市太和醫院治療的青年乳腺癌患者（≤35歲）的89例臨床資料，分析其臨床病理特點及預后影響因素。 結果 青年乳腺癌患者手術治療86例，解救性治療3例。手術患者中Luminal A型21例，Luminal B型16例，HER-2過表達型11例，三陰性乳腺癌38例，浸潤性導管癌73例，臨床分期Ⅱ期為54.6%和Ⅲ期為24.4%。各分子分型在腫瘤大小、臨床分期、Ki67、淋巴結轉移等指標的比較，差異無統計學意義（P > 0.05）。隨訪3年和5年各分子分型的復發轉移及生存率比較，差異無統計學意義（P > 0.05）。腫瘤大小、淋巴結轉移、Ki67、年齡和臨床分期是影響青年乳腺癌預后的主要因素（P < 0.05），其中淋巴結轉移、腫瘤大小、臨床分期是影響預后的獨立危險因素（P < 0.05）。 結論 青年乳腺癌以三陰性患者居多，臨床分期較晚，腫瘤大小與淋巴結轉移對預后影響較大，需早診斷早治療，以期提高預后，但分子分型對預后的影響還需進一步研究。

[關鍵詞] 乳腺癌;青年;分子分型;預后

[中圖分類號] R737.9? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-7210（2020）03（b）-0117-04

[Abstract] Objective To investigate the clinicopathological characteristics and prognostic differences of patients with different molecular types of breast cancer at the age of 35 and below， and to analyze the prognostic factors. Methods The clinical data of 89 cases of young breast cancer patients （≤35 years old） treated in Taihe Hospital of Shiyan City， Hubei Province from February 2007 to January 2014 were retrospectively analyzed， and the clinicopathological characteristics and prognostic factors were analyzed. Results There were 86 cases of surgical treatment and 3 cases of salvage treatment in young breast cancer patients. Surgery in patients with Luminal A type 21 cases， 16 cases of Luminal B type， HER-2 overexpression was found in 11 cases， triple negative breast cancer 38 cases， invasive ductal carcinoma in 73 cases， clinical staging Ⅱ period 54.6% and Ⅲ period was 24.4%. There was no significant difference in tumor size， clinical stage， Ki67， lymph node metastasis and other indicators in different molecalar types （P > 0.05）. There was no statistically significant difference in recurrence， metastasis and survival rate between 3 and 5 years of follow-up （P > 0.05）. Tumor size， lymph node metastasis， Ki67， age and clinical stage were the main factors influencing the prognosis of young breast cancer （P < 0.05）. Lymph node metastasis， tumor size and clinical stage were independent risk factors for prognosis （P < 0.05）. Conclusions The majority of young breast cancer patients are triple negative， and the clinical stage is late. Tumor size and lymph node metastasis have a great influence on the prognosis， so early diagnosis and early treatment are needed to improve the prognosis. However， the effect of molecular typing on the prognosis needs to be further studied.

[Key words] Breast cancer; Young; Molecular types; Prognosis

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（收稿日期：2019-07-02? 本文編輯：封? ?華）