关键词:乳腺肿瘤,预后,手术,新辅助化疗

Abstract:

ObjectiveTo analyze the clinical features and the effects of different treatments on 5-year overall survival (OS) rate and 5-year disease free survival (DFS) rate of stage 0-Ⅲ triple-negative breast cancer (TNBC).MethodsThe data of 209 patients diagnosed as stage 0-Ⅲ TNBC in Ward 2 of Department of General Surgery of the Fifth Medical Center of PLA General Hospital from January 2004 to December 2013 were selected. The relationships between the clinical features, treatments and 5-year OS rate, 5-year DFS rate were retrospectively analyzed. Kaplan-Meier method was used to draw survival curves, and Cox proportional risk model was used for multivariate analysis.ResultsUnivariate analysis found that clinical stage and methods of surgery were associated with 5-year OS rate (χ²=52.615,P<0.001;χ²=17.329,P=0.001) and 5-year DFS rate (χ²=55.112,P<0.001;χ²=18.816,P<0.001). Multivariate analysis showed that clinical stage was an independent prognostic factor of DFS (HR=3.637, 95%CI: 2.146-6.164,P<0.001) and OS (HR=3.545, 95%CI: 2.091-6.009, P<0.001). For the TNBC patients without axillary lymph node metastasis (n=118), the 5-year OS rates of patients with breast conservation surgery + sentinel lymph node biopsy, total breast resection + sentinel lymph node biopsy, modified radical mastectomy and breast conserving surgery + axillary lymph node dissection were 97.6%, 97.7%, 91.4%, 100% respectively, the 5-year DFS rates were 97.3%, 94.3%, 85.8%, 100% respectively, and there were no significant differences among the four groups (χ²=3.369,P=0.338;χ²=3.868,P=0.276). The 5-year OS rate (74.5%vs. 91.1%) and 5-year DFS rate (73.6%vs. 86.8%) were significantly different in patients receiving neoadjuvant chemotherapy (n=106) compared with those receiving adjuvant chemotherapy (n=80) (χ²=4.504,P=0.034;χ²=4.683,P=0.030). The patients receiving neoadjuvant chemotherapy had later clinical stages than those receiving adjuvant chemotherapy (χ²=35.314,P<0.001). There were no significant differences in 5-year OS rate and 5-year DFS rate between the patients receiving neoadjuvant chemotherapy and adjuvant chemotherapy with the same clinical stage (allP>0.05). The 5-year OS rates of patients with pathologic complete response (pCR), partial response (PR) and stable disease (SD) obtained by neoadjuvant chemotherapy were 100%, 75.8% and 57.1% respectively, and the 5-year DFS rates were 100%, 74.5% and 55.7% respectively, with statistically significant differences (χ²=10.086,P=0.006;χ²=10.399,P=0.006). Between the pCR group and the PR group, the 5-year OS rate (χ²=4.238,P=0.040) and 5-year DFS rate (χ²=4.525,P=0.033) were significantly different. Between the pCR group and the SD group, the 5-year OS rate (χ²=8.163,P=0.004) and 5-year DFS rate (χ²=8.509,P=0.004) were significantly different. Between the PR group and the SD group, the 5-year OS rate (χ²=3.931,P=0.047) and 5-year DFS rate (χ²=3.896,P=0.048) were significantly different.ConclusionFor the patients with stage 0-Ⅲ TNBC, clinical stage is an independent prognostic factor. For the TNBC patients without axillary lymph node metastasis, breast conservation surgery + sentinel lymph node biopsy, total breast resection + sentinel lymph node biopsy, modified radical mastectomy and breast conserving surgery + axillary lymph node dissection have similar outcomes. There is no significant difference between neoadjuvant chemotherapy and adjuvant chemotherapy in the prognosis of patients with the same clinical stage, but patients with pCR or PR obtained by neoadjuvant chemotherapy can achieve better survival.

Key words:Breast neoplasms,Prognosis,Surgery,Neoadjuvant chemotherapy