Department of Surgical Sciences, University of Insubria, Varese, Italy.
Breast J. 2010 Sep-Oct;16 Suppl 1:S29-33. doi: 10.1111/j.1524-4741.2010.01000.x.
To determine which tumor-related factors might predispose the patient to loco-regional recurrence or death and the impact of these factors on the different types of events. We retrospectively analyzed the data of 1991 women between January 1998 and March 2010 for a first primary nonmetastatic breast cancer and treated with surgery and neo-adjuvant/adjuvant therapy. The overall survival distribution was estimated using the Kaplan-Meier method. The prognostic impact of several factors on cumulative overall and loco-regional recurrence free survival was evaluated by univariate (log-rank test) and multivariate analysis (Cox regression). At log-rank test, pT, nodal status, histotype, grading, lymphangioinvasive growth, tumor diameter, estrogen receptors (ER) status, progesterone receptors (PR) status, expression of Ki67, and expression of Her2/neu had a prognostic value on loco-regional recurrence or overall survival. In the multivariate analysis grading remained the only independent predictor of loco-regional recurrences. With regard to overall survival, the Cox model selected grading along with nodal status and PR status. Loco-regional recurrences after breast cancer surgery are not frequent events. They are markers of tumor aggressiveness and predictor of an increased likelihood of cancer-related death. However, loco-regional recurrence and systemic tumor progression are partially independent events, since some prognostic factors differ.
为了确定哪些肿瘤相关因素可能使患者易于发生局部区域复发或死亡，以及这些因素对不同类型事件的影响。我们回顾性分析了 1998 年 1 月至 2010 年 3 月间 1991 例首次原发非转移性乳腺癌患者的数据，这些患者接受了手术和新辅助/辅助治疗。使用 Kaplan-Meier 方法估计总生存率分布。通过单因素（对数秩检验）和多因素分析（Cox 回归）评估多个因素对累积总生存和局部区域无复发生存的预后影响。在对数秩检验中，pT、淋巴结状态、组织学类型、分级、淋巴管侵犯生长、肿瘤直径、雌激素受体（ER）状态、孕激素受体（PR）状态、Ki67 表达和 Her2/neu 表达对局部区域复发或总生存有预后价值。在多因素分析中，分级仍然是局部区域复发的唯一独立预测因子。关于总生存，Cox 模型选择了分级、淋巴结状态和 PR 状态。乳腺癌手术后的局部区域复发并不常见。它们是肿瘤侵袭性的标志物，也是癌症相关死亡风险增加的预测因子。然而，局部区域复发和全身肿瘤进展是部分独立的事件，因为一些预后因素不同。
