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学科主题: 肿瘤学
题名:
乳腺癌术后单纯胸壁复发患者的临床特征及预后因素分析
作者: 徐睿
答辩日期: 2016-05-19
导师: 李惠平
专业: 肿瘤学
授予单位: 北京大学
授予地点: 北京大学临床肿瘤学院
学位: 硕士
关键词: 乳腺癌 ; 胸壁复发 ; 预后因素 ; 治疗
其他题名: Clinical Features and Prognosis of Breast Cancer Patients with Chest Wall Recurrence after Mastectomy
分类号: R737.9
摘要:

背景及目的:乳腺癌发病率在中国逐年提高,目前居中国女性癌症发病率之首。关于乳腺癌根治/改良根治术后局部/区域复发率的报道从5%-30%不等,其中以胸壁复发最为常见。随着多学科综合治疗的发展、多种治疗手段的应用,乳腺癌早期局部控制率及死亡率已较前有所下降,但目前对部分治疗手段仍存在争议,如局部胸壁复发后复发灶是否应行手术切除、胸壁复发后全身性治疗联合局部治疗的获益及必要性等。为探讨乳腺癌术后胸壁复发患者的预后因素及相关治疗方式,我们进行了本项临床研究。

方法:收集2012年5月至2016年4月北京大学肿瘤医院乳腺肿瘤内科收治的76例根治术/改良根治术后以胸壁复发为首发转移部位的乳腺癌患者的临床资料,分析各项临床-病理因素同局部复发率、局部控制率及总生存期之间的关系,自2014年8月后15例患者行循环肿瘤细胞(CTC)检测,收集这部分患者的CTC检测结果。回顾分析万方及PubMed数据库中的相关文献,进行汇总分析。

结果:76例乳腺癌患者均为女性,发病年龄为26-67岁,中位发病年龄44岁。病理类型以浸润性导管癌为主。乳腺癌术后无病生存期(DFS)为7~300个月,中位DFS40个月。随访76例患者中局部复发后55例发生再次进展,无进展生存期(PFS) 2~120个月。患者诊断乳腺癌后总生存时间为18-334个月。乳腺癌胸壁复发后总生存期(OS)3-273个月,其中胸壁复发后行复发灶手术切除者OS为3-273个月,中位54个月,未行复发灶手术切除者OS为5-120个月,中位32个月。

单因素分析显示:患者原发肿瘤ER阳性、淋巴结阳性数目零或较少可使术后DFS延长,P<0.05。乳腺癌分期早、原发肿瘤较小、腋窝淋巴结阳性数目较少及脉管癌栓阴性、激素受体阳性、HER2阴性及Ki-67表达<20%、DFS>2年、行术后辅助内分泌治疗及综合治疗可提高患者10年生存率(生存率差异>10%);其中乳腺癌分期、ER状态、Ki-67表达水平及乳腺癌术后DFS对患者乳腺癌诊断后OS的影响有统计学意义,P<0.05。局部胸壁复发后ER阳性、复发灶行手术切除可延长胸壁复发后PFS、OS,改善局部控制率及总生存,P<0.05,复发PR阳性及行放疗治疗对PFS及复发后OS有延长趋势。复发HER2阴性及乳腺癌术后DFS>2年对患者复发后OS有延长趋势(年生存率相差>10%)。

结论:乳腺癌术后胸壁复发有相对较好的预后,但仍存在远处转移及死亡风险,明确复发高危因素,采取合理的局部治疗及系统性治疗方式可以更好的改善患者的局部复发率、局部控制率及远处转移风险。CTC结果显示胸壁复发患者CTC数量较少,与发生远处转移者CTC数量存在统计学差异,P<0.05,进一步证实胸壁复发不同于远处转移,行手术切除胸壁复发灶达到显微镜下无残留的患者将有良好的预后。

英文摘要:

Background and Objective:The incidence of breast cancer in China increased year by year. At present, it is in the first place of female cancer incidence in China. The locoregional recurrence rate after mastectomy or modified mastectomy is ranging from 5% to 30%, among them, chest wall recurrence(CWR) is the most common. With the development of multi-disciplinary treatment and the application of variety treatment methods, the local control rate and mortality of early breast cancer has declined than before. But some of the treatment methods still have controversial. For example, whether chest wall recurrence lesions should be removed surgically, or the benefit and necessity of local treatment with systemic therapy after chest wall recurrence. To analysis the clinical features, treatment methods and prognosis of breast cancer patients with chest wall recurrence after mastectomy, we carried out this research.
Method: During 2012-2016, 76 patients with identified CWR as the first recurrence site were treated at our hospital. We collected their clinical-pathologic data, analyzed the relations of the various factors with local recurrence rate, local control rate and survival. After august of 2014, some patients conducted the CTC detection, we colleted their CTC results. Furthermore, reviewed related literatures in the database of WANFANG and PubMed. 
Result: Of the patients, the onset age is ranging from 26-67 years old, median onset age is 44 years old. The pathological type is most of invasive ductal carcinoma. The disease-free survival time after operation is from 7 to 300 months, with a median survival time of 40 months. After chest wall recurrence, the progression free survival time is from 2-120 months. The overall survival time after chest wall recurrence was from 3 to 273 months, with a median survival time of 54 months and 32 months respectively for have surgical removal of the recurrence or not. 
On univariate analysis, positive ER status, small number of positive lymph nodes can prolong the DFS, P<0.05. Early breast cancer staging, small tumor size, negative lymph nodes and with no blood vessel invasion, positive hormone receptor, negative Her-2 receptor status, Ki-67≤20%, DFS>24months, adjuvant endocrine therapy and systemic therapy can increase 10 year survival rate. Among them, the breast cancer staging, ER status, Ki-67 expression and the DFS after breast cancer operation are associated with the OS, P<0.05. After CWR, positive ER status of recurrent tumor foci and have surgical removal of the recurrent foci are associated with the longer PFS and OS, P<0.05.The PR status and radiotherapy for CWR have the correlation trend with PFS. Positive PR status and negative HER-2 expression of recurrent foci, radiotherapy, the DFS after breast cancer operation>24 months have the correlation trend with the longer overall survival time after CWR. 
Conclusion: Postoperative chest wall breast cancer recurrence has relatively good prognosis, but its still have the risk of distant metastases and death. To know exactly about the high risk factors of recurrence, take reasonable treatment methods can improve the local control rate and reduce the risk of distant metastases. The CTC detection of chest wall recurrence patients shows a small number of CTC, it’s different from patients with distant metastasis, the two groups have significant statistical difference, P<0.05. Further confirmed that patients with surgical removal of the recurrent foci achieve R0 can have a good prognosis.

 

语种: 中文
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/125699
Appears in Collections:北京大学临床肿瘤学院_学位论文

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作者单位: 北京大学临床肿瘤学院

Recommended Citation:
徐睿. 乳腺癌术后单纯胸壁复发患者的临床特征及预后因素分析[D]. 北京大学临床肿瘤学院. 北京大学. 2016.
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