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目的分析老年乳腺癌患者临床病理学特征及不同分子分型之间的差异,了解老年乳腺癌患者的生存状态,探讨老年乳腺癌患者预后的独立影响因素。方法收集2004年1月至2008年12月本院收治210例可手术老年乳腺癌患者的临床病理资料,并回顾性分析其临床病理学特征、复发转移及生存情况。结果本组患者5年无病生存率和5年总生存率分别为80.6%和85.6%。单因素分析结果显示影响患者无病生存时间的因素有淋巴结状况(P=0.020),肿物大小(P=0.049)和内分泌治疗(P=0.032)。影响本组患者总生存时间的因素有淋巴结状况(P=0.005),TNM分期(P=0.021)和内分泌治疗(P=0.015)。Cox多因素分析示淋巴结状况和内分泌治疗为影响患者无病生存时间和总生存时间的独立因素。不同分子分型乳腺癌患者DFS和OS不同,其中,Luminal A型复发转移率最低,而Basal-like型复发转移率高于其他类型,总生存时间最短。结论老年乳腺癌患者病理类型以浸润性导管癌为主,临床分期较早,其公认的治疗方式仍以手术治疗为主,其预后与淋巴结状况和内分泌治疗有关。应注意早期诊断,受体阳性时给予充分内分泌治疗,并根据分子分型制定合理的个体治疗方案。
Objective To analyze the clinicopathological characteristics and different molecular types of breast cancer in elder patients, to understand the survival status of elder patients with breast cancer and to explore the independent prognostic factors of elder breast cancer patients. Methods The clinical and pathological data of 210 patients with operable elderly breast cancer admitted to our hospital from January 2004 to December 2008 were retrospectively analyzed. The clinicopathological characteristics, recurrence, metastasis and survival were retrospectively analyzed. Results The 5-year disease-free survival rate and 5-year overall survival rate in this group were 80.6% and 85.6% respectively. The results of univariate analysis showed that the factors influencing disease-free survival were lymph node status (P = 0.020), tumor size (P = 0.049) and endocrine therapy (P = 0.032). The factors influencing the overall survival of patients in this group were lymph node status (P = 0.005), TNM stage (P = 0.021) and endocrine therapy (P = 0.015). Cox multivariate analysis showed that lymph node status and endocrine therapy were independent factors influencing disease-free survival and overall survival time. Different breast cancer patients with different molecular types of DFS and OS are different, of which, Luminal A type recurrence and metastasis rate is lowest, while the Basal-like recurrence and metastasis rate is higher than the other types, the shortest total survival time. Conclusion The pathological types of elderly patients with breast cancer are mainly invasive ductal carcinoma with an earlier clinical stage. The accepted treatment is still mainly based on surgical treatment, and its prognosis is related to lymph node status and endocrine therapy. Should pay attention to early diagnosis, when the receptor is given full endocrine therapy, and according to the molecular type to develop a reasonable individual treatment programs.