摘要目的 探讨首诊Ⅳ期乳腺癌患者的临床病理特征,及其与发病和预后的关系.方法 对2008年1月至2014年12月北京大学第一医院乳腺疾病中心治疗的66例首诊Ⅳ期乳腺癌病例进行回顾性分析,患者均为女性,中位年龄57.5(31 ～80)岁,占同期收治新发乳腺癌的3.01％(66/2 189).分析发病年龄、T分期、N分期及免疫组化表型等临床病理特征与发病及预后之间的相关性,采用x2检验分析临床病理因素对肿瘤转移的影响,利用Kaplan-Meier曲线计算生存期,通过Log-rank检验进行单因素分析,采用Cox风险回归模型进行多因素分析,应用后退法筛选影响生存的危险因素.结果 首诊Ⅳ期乳腺癌66例中位生存期56个月,5年生存率为40％.年龄、分子分型、组织学分级、激素受体及人类表皮生长因子受体2(HER2)状态对器官转移的影响均无统计学意义.多因素分析结果显示,HER2(P =0.003)及激素受体状态(P=0.001)、单一器官转移(P =0.029)与生存相关;原发病灶R0手术组与非手术组总生存期及5年生存率差异无统计学意义(P =0.102).结论 临床病理特征与首诊Ⅳ期乳腺癌发病暂未发现关联.HER2、激素受体状态、单一器官转移与此类患者的生存相关.

abstractsObjectives To explore the clinical and pathological characteristics of stage Ⅳ breast cancer and to analyze their relationship with the morbidity and prognosis.Methods The records of 66 patients presenting from January 2008 to December 2014 with stage Ⅳ breast cancer were reviewed.All of the patients were women and the median age was 57.5 (31 to 80) years,accounted for 3.01％ (66/2 189) among the breast cancer patients treated in the same period.Statistical methods were used to analyze the correlation between clinical and pathological characteristics such as T-stage,N-stage,immuno-histo-chemistry and the morbidity and prognosis of stage Ⅳ breast cancer.The influence of patients characteristics to metastasis were compared by x2 test.Kaplan-Meier curves were reported for overall survival (OS),and the Log-rank test was used to compare the difference in groups.Cox proportional models were fitted for multivariate analysis.Results The median survival time of stage Ⅳ breast cancer was 56.0months and the 5-year survival rate was 40％.To metastasis,the effects of age,subtypes,histological grade,hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) had no significant statistics differences.It was concluded that the expression of HER2 (P =0.003) and HR (P =0.001) as well as single metastasis (P =0.029) were the influencing factors of the survival by muhivariate Cox regression analysis.Primary tumor R0 surgery group and no surgery group had no significant statistics differences of overall survival and the 5-year survival rate (P =0.102).Conclusions Clinical and pathological characteristics have no effect on metastasis.The expression of HER2 and HR as well as single metastasis play important roles in survival.