摘要
目的 分析不同组织学分级乳腺癌放疗患者生理特征参数差异及5年预后的影响因素.方法 回顾性选取2015年4月至2018年4月在江苏省肿瘤医院接受放疗的80例乳腺癌患者进行研究.根据Bloom Richardson标准将患者进行组织学分级,并将其分为0～Ⅰ级组(n=30)和Ⅱ～Ⅲ级组(n=50).分析0～Ⅰ级和Ⅱ～Ⅲ级患者生理特征参数(年龄、肿瘤位置、体重指数、胸围和患侧乳腺体积)的差异;经随访记录5年后0～Ⅰ级和Ⅱ～Ⅲ级患者的局部复发、远处转移、总生存率;分析预后良好组和预后不良组患者的生理特征参数差异;并建立多因素Logistic模型,分析影响不同乳腺癌预后的独立危险因素.结果 Ⅱ～Ⅲ级组体重指数＞24 kg/m2、胸围≥90 cm、患侧乳腺体积≥350 cm3的患者比率分别为64.00％、80.00％、76.00％,均明显高于0～Ⅰ级组(33.33％、30.00％、36.67％),差异均有统计学意义(P＜0.05).Ⅱ～Ⅲ级组患者的局部复发率、远处转移率分别为32.00％、40.00％,均高于0～Ⅰ级组(10.00％、16.67％),5年总生存率为64.00％,低于0～Ⅰ级组(86.67％),差异均有统计学意义(P＜0.05).80例乳腺癌患者5年后的预后良好58例,预后良好率为72.50％,预后不良22例,预后不良率为27.50％.预后不良组与预后良好组患者年龄≥60岁、体重指数＞24 kg/m2、胸围≥90 cm、患侧乳腺体积≥350 cm3、组织学Ⅱ～Ⅲ级比率比较,差异均有统计学意义(P＜0.05).单因素分析结果显示,年龄、体重指数、胸围、患侧乳腺体积、组织学分级均是影响乳腺癌5年预后的危险因素(P＜0.05).多因素Logistic分析结果显示,年龄≥60岁、体重指数＞24 kg/m2、胸围≥90 cm、患侧乳腺体积≥350 cm3、组织学Ⅱ～Ⅲ级均是影响乳腺癌患者放疗5年预后的独立危险因素(P＜0.05).结论 体重指数、胸围和患侧乳腺体积等生理特征与乳腺癌组织学分级有关,同时也是威胁乳腺癌放疗远期预后的独立危险因素.
Abstract
Objective To analyze the differences of physiological characteristic parameters and the influencing factors of 5-year progno-sis in breast cancer patients with different histological grades.Methods Eighty patients with breast cancer who received radiotherapy in Jiangsu Provincial Cancer Hospital from April 2015 to April 2018 were selected for the study.According to the Bloom Richardson standard,the patients were histologically graded and divided into grade 0-Ⅰ group(n=30)and grade Ⅱ-Ⅲ group(n=50);the differences of physiological char-acteristic parameters[age,tumor location,body mass index,chest circumference and ipsilateral breast volume]between grade 0-Ⅰ and gradeⅡ-Ⅲ patients were analyzed.The local recurrence,distant metastasis and overall survival rate of patients with grade 0-Ⅰ and grade Ⅱ-Ⅲafter 5 years were recorded.The differences of physiological characteristic parameters between the good prognosis group and the poor prognosis group were analyzed.Multivariate Logistic model was established to analyze the independent risk factors affecting the prognosis of different breast cancer.Results The rates of patients with body mass index＞24 kg/m2,chest circumference ≥90 cm,and affected breast volume ≥350 cm3 in the grade Ⅱ-Ⅲ group were 64.00％,80.00％,and 76.00％,respectively,which were significantly higher than those in the grade 0-Ⅰ group(33.33％,30.00％,36.67％),and the differences were statistically significant(P＜0.05).The local recurrence rate and distant metastasis rate of the grade Ⅱ-Ⅲ group were 32.00％and 40.00％,respectively,which were higher than those in the grade 0-Ⅰ group(10.00％and 16.67％),the overall 5-year survival rate was 64.00％,which was lower than that in the grade 0-Ⅰ group(86.67％),and the differences were statistically significant(P＜0.05).Five years later,58 of 80 patients with breast cancer had a good prognosis,with a good prognosis rate of 72.50％,and 22 had a bad prognosis,with a bad prognosis rate of 27.50％.There were statistically significant differences between the poor prognosis group and the good prognosis group in ratio of patients with age ≥60 years old,body mass index＞24 kg/m2,chest circumference ≥90 cm,affected breast volume ≥350 cm3,and histological grade Ⅱ-Ⅲ(P＜0.05).Univariate analysis showed that age,body mass index,chest circumference,ipsilateral breast volume and histological grade were risk factors affecting the 5-year prognosis of breast cancer(P＜0.05).Mul-tivariate Logistic analysis showed that age ≥60 years,body mass index＞24 kg/m2,chest circumference ≥90 cm,ipsilateral breast volume≥350 cm3,histological grade Ⅱ-Ⅲ were independent risk factors affecting the 5-year prognosis of breast cancer patients treated with radiotherapy(P＜0.05).Conclusion Physiological characteristics such as body mass index,chest circumference and breast volume on the affected side are re-lated to the histological grade of breast cancer,and are also independent risk factors that threaten the long-term prognosis of breast cancer radio-therapy.
NETL
NSTL
维普
万方数据