Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
Second Outpatient Department of Traditional Chinese Internal Medicine, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China.
Biosci Rep. 2019 Apr 16;39(4). doi: 10.1042/BSR20190231. Print 2019 Apr 30.
The present study aimed to discuss the impacts of changes to pathological indicators of patients with breast cancer upon the incidence of postoperative lymphedema of the upper limb and prognosis. 2597 female patients with breast cancer who received surgical treatment in our hospital were enrolled in the present study to evaluate the incidence of these patients' postoperative lymphedema of the upper limb. For patients with breast cancer, the incidence of postoperative lymphedema of the upper limb was related to T stage of breast cancer, lymph node metastasis, the number of metastatic lymph nodes, pTNM stage, and pathological types of breast cancer (<0.05). Lymph node metastasis was an independent risk factor of lymphedema of the upper limb; lymph node metastasis and Ki-67 expression level were independent factors that impacted pathologic complete response rate of neoadjuvant chemotherapies. Patients' mortality was correlated to pathological and molecular subtypes, Ki-67 expression level, ER expression level, PR expression level, and pTNM stage (<0.05), among which the pTNM stage, Ki-67 expression level, and PR expression level were independent factors that affected prognosis of patients with breast cancer. Patients with lymph node metastasis were more prone to lymphedema of the upper limb, while it was easier for those whose Ki-67 expression level was high and who were not subject to lymph node metastasis to get a pathological complete response after receiving neoadjuvant chemotherapies. The prognosis was poorer among patients whose progesterone receptors were negative and Ki-67 expression levels were high at the advanced pTNM stage.
本研究旨在探讨乳腺癌患者病理指标变化对术后上肢淋巴水肿发生及预后的影响。选取我院收治的 2597 例乳腺癌手术患者,评估患者术后上肢淋巴水肿的发生情况。乳腺癌患者术后上肢淋巴水肿的发生与乳腺癌 T 分期、淋巴结转移、转移淋巴结数目、pTNM 分期、乳腺癌病理类型有关(<0.05)。淋巴结转移是上肢淋巴水肿的独立危险因素;淋巴结转移、Ki-67 表达水平是新辅助化疗病理完全缓解率的独立影响因素。患者死亡率与病理和分子亚型、Ki-67 表达水平、ER 表达水平、PR 表达水平、pTNM 分期有关(<0.05),其中 pTNM 分期、Ki-67 表达水平、PR 表达水平是影响乳腺癌患者预后的独立因素。有淋巴结转移的患者更易发生上肢淋巴水肿,Ki-67 表达水平高且无淋巴结转移的患者接受新辅助化疗后更容易获得病理完全缓解。孕激素受体阴性、Ki-67 表达水平高、pTNM 分期较晚的患者预后较差。