Ugnat A M, Xie L, Morriss J, Semenciw R, Mao Y
Surveillance and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Population and Public Health Branch, Health Canada, Ottawa, ON, Canada K1A 0K9.
Br J Cancer. 2004 Mar 22;90(6):1138-43. doi: 10.1038/sj.bjc.6601662.
This study examined the 5-year survival of 2192 breast cancer women diagnosed between 1994 and 1997 in Ottawa, Canada, by age, TNM stage, histology, grade and treatment, including assessment of the independent value of variables in defining prognosis. Our results showed that age, stage, treatment and grade significantly influenced outcome regardless of the confounding factors considered, with histology failing to achieve significant independent prognostic information. The survival rates were highest at ages 50-69 years for stage I and at ages 40-49 years for stages II-IV. The rates were lowest at ages <or=39 years for stages I-II and at ages >or=70 years for stages III-IV. The differences in survival between grade 1 and grade 3 were 9% in stage I and 20% in stage II. The treatment leading to the best survival was surgery plus radiation for stages I-II and surgery combined with chemotherapy for stages III-IV. Lobular carcinoma had a better prognosis than ductal carcinoma; this can be explained by more grade 1 and less grade 3 cases in lobular carcinoma. The worse prognosis for young patients than other ages can be explained by their higher proportion of poorly differentiated cancers. Stage I patients aged 50-69 years having the best survival is likely due to the earlier diagnosis achieved through screening.
本研究调查了1994年至1997年间在加拿大渥太华被诊断为乳腺癌的2192名女性患者的5年生存率，分析了年龄、TNM分期、组织学类型、分级及治疗方式等因素，包括评估各变量在定义预后方面的独立价值。我们的结果显示，无论考虑哪些混杂因素，年龄、分期、治疗和分级均对预后有显著影响，而组织学类型未能提供显著的独立预后信息。I期患者50 - 69岁时生存率最高，II - IV期患者40 - 49岁时生存率最高。I - II期患者年龄≤39岁时生存率最低，III - IV期患者年龄≥70岁时生存率最低。I期1级和3级患者的生存率差异为9%，II期为20%。I - II期患者手术加放疗、III - IV期患者手术联合化疗的生存率最佳。小叶癌的预后优于导管癌；这可以通过小叶癌中1级病例较多、3级病例较少来解释。年轻患者预后较差可归因于其低分化癌症比例较高。I期50 - 69岁患者生存率最佳可能是由于通过筛查实现了早期诊断。
