Ong Teng Aik, Yip Cheng Har
Department of Surgery, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Kuching, Sarawak, Malaysia.
Asian J Surg. 2003 Jul;26(3):169-75. doi: 10.1016/S1015-9584(09)60378-X.
To study the impact of various clinicopathological factors on short-term survival in a cohort of breast cancer patients treated at the University of Malaya Medical Centre (UMMC).
All cases of breast cancer treated at UMMC from January 1999 to June 2001, except for stage IV disease, were included in the study. Survival analysis was carried out using Kaplan-Meier for univariate analysis and Cox regression for multivariate analysis. The log-rank test was used to test the significance of differences between the different survival curves.
A total of 385 patients were included. The mean patient age at presentation was 50.3 years (SD, 11.4); 198 (51.4%) patients had lymph node-positive disease, and 187 (48.6%) had node-negative disease. The mean follow-up period was 18.7 months (SD, 8.8). The Malay ethnic group, tumours of larger size, node-positive disease, more than five positive lymph nodes, oestrogen receptor (ER) negativity and the presence of lymphovascular invasion were significant prognostic factors for shorter recurrence-free survival (RFS) in the univariate analysis. In the multivariate analysis, ER negativity was the only independent adverse prognostic factor for RFS. For overall survival (OS), tumours of larger size, node-positive disease, more than five positive lymph nodes, ER negativity and high grade tumours were associated with significantly shorter OS. However, more than five positive lymph nodes was the only independent prognostic factor for shorter OS in the multivariate analysis. Further multivariate analysis of the patients with node-positive disease showed that the Malay ethnic group, ER negativity and more than five positive lymph nodes were independent prognostic factors for shorter RFS. On the other hand, ER negativity and more than five positive lymph nodes were independent negative prognostic factors for OS in this subgroup of patients.
The evaluation of various prognostic factors would provide useful information on disease progression in local patients, especially for the planning of adjuvant therapies and follow-up protocols. Differences in the pattern of breast cancer among the different ethnic groups in Malaysia warrant further studies.
研究多种临床病理因素对在马来亚大学医学中心（UMMC）接受治疗的一组乳腺癌患者短期生存的影响。
纳入1999年1月至2001年6月在UMMC接受治疗的所有乳腺癌病例，但IV期疾病除外。采用Kaplan-Meier法进行单因素生存分析，采用Cox回归进行多因素分析。采用对数秩检验来检验不同生存曲线之间差异的显著性。
共纳入385例患者。患者就诊时的平均年龄为50.3岁（标准差，11.4）；198例（51.4%）患者有淋巴结阳性疾病，187例（48.6%）有淋巴结阴性疾病。平均随访期为18.7个月（标准差，8.8）。在单因素分析中，马来族、肿瘤较大、淋巴结阳性疾病、五个以上阳性淋巴结、雌激素受体（ER）阴性以及存在淋巴管浸润是无复发生存期（RFS）较短的显著预后因素。在多因素分析中，ER阴性是RFS唯一独立的不良预后因素。对于总生存期（OS），肿瘤较大、淋巴结阳性疾病、五个以上阳性淋巴结、ER阴性和高级别肿瘤与显著较短的OS相关。然而，在多因素分析中，五个以上阳性淋巴结是OS较短的唯一独立预后因素。对淋巴结阳性疾病患者进行的进一步多因素分析表明，马来族、ER阴性和五个以上阳性淋巴结是RFS较短的独立预后因素。另一方面，在该亚组患者中，ER阴性和五个以上阳性淋巴结是OS的独立阴性预后因素。
对各种预后因素的评估将为当地患者的疾病进展提供有用信息，特别是在辅助治疗计划和随访方案方面。马来西亚不同种族间乳腺癌模式的差异值得进一步研究。
