基于大型综合医院单中心乳腺癌手术病人10年诊治和生存分析
收稿日期: 2020-07-24
网络出版日期: 2022-07-27
基金资助
国家自然科学基金(81772797);上海教育委员会高峰高原计划—研究型医师(20172007);瑞金医院“广慈卓越青年培养计划”项目(GCQN-2017-A18)
Diagnosis, treatment and survival of breast cancer patients in single large hospital: a 10-year analysis
Received date: 2020-07-24
Online published: 2022-07-27
目的:评估瑞金医院乳腺癌手术病人的诊治和预后,为进一步临床诊疗和研究开展提供基础。方法:入组2009年1月至2018年12月在我院乳腺疾病诊治中心手术治疗的非晚期乳腺癌病人,分析临床病理特征、保乳手术、前哨淋巴结活检(sentinel lymph node biopsy, SLNB)以及在不同手术年份的变化趋势。用Kaplan-Meier曲线分析并比较不同治疗方案乳腺癌病人的5年和10年无病生存(disease free survival, DFS)和总生存(overall survival, OS)。结果:共8 210例入组。乳腺原位癌为959例(11.7%)。在未接受新辅助治疗的7 549例病人中,淋巴结阴性为5 379例(71.3%),0期和I期分别为949例(12.6%)和2 964例(39.3%)。2 377例(29.0%)接受保乳手术,占乳腺癌手术比例从2009年的16.5%上升到2013年的34.8%。4 149例(52.5%)接受SLNB,从2009年的0.6%上升至2018年的69.3%。2009年至2018年入组的所有乳腺癌病人均进行完整随访。中位随访46个月。5年和10年DFS率分别为87.6%和80.5%;5年和10年OS率分别为94.2%和90.7%。2009年至2014年手术治疗的3 800例乳腺癌病人,中位随访时间79个月,5年DFS率和OS率分别为86.9%和93.1%,10年DFS率和OS率分别为79.1%和88.4%。结论:瑞金医院乳腺癌手术病人的保乳手术和SLNB比例在10年间逐渐提高。在现代乳腺癌治疗模式下,乳腺癌病人5年OS率超过93%。本研究结果可指导乳腺癌临床诊治策略的制定和进一步研究。
陈小松, 李帅, 吴佳毅, 黄欧, 柴维敏, 姚洁洁, 朱樱, 许赪, 陈佳艺, 瞿晴, 费晓春, 丁晓毅, 林琳, 张男, 方琼, 何建蓉, 朱丽, 李亚芬, 陈伟国, 沈坤炜 . 基于大型综合医院单中心乳腺癌手术病人10年诊治和生存分析[J]. 外科理论与实践, 2021 , 26(02) : 149 -158 . DOI: 10.16139/j.1007-9610.2021.02.012
Objective: To analyze the diagnosis, treatment and prognosis of breast cancer patients in Ruijin Hospital for further clinical management and study. Methods Non-metastatic breast cancer patients with surgical treatment in our hospital were included from January 2009 to December 2018. Clinicopathological features of enrolled patients and chan-ging trend of different surgery including breast conserving surgery and sentinel lymph node biopsy (SLNB) in the period of this study were analyzed. Kaplan-Meier curve analysis was used to compare 5-year and 10-year disease free survival (DFS) and overall survival(OS) of patients with different treatments. Results This study had 8 210 patients. There were 959 (11.7%) patients with in situ disease and 5 379(71.3%) patients with negative lymph node in 7 549 patients without neoadjuvant therapy. There were 949(12.6%) cases and 2964 (39.3%) cases with breast cancer at stage 0 and stage I, respectively. A total of 2377(29.0%) patients underwent breast conserving surgery with increase from 16.5% in 2009 to 34.8% in 2013. The patients with SLNB were 4149 cases (52.5%) from 0.6% in 2009 to 69.3% in 2018. All patients from 2009 to 2018 achieved complete follow-up with a median follow-up of 46 months: 5-year and 10-year DFS were 87.6% and 80.5%; 5-year and 10-year OS were 94.2% and 90.7%, respectively. There were 3800 patients with surgery followed from year 2009 to 2014 with a median-follow-up of 79 months: 5-year DFS rate and OS rate were 86.9% and 93.1%; 10-year DFS rate and OS rate were 79.1% and 88.4%, respectively. Conclusions Both rates of breast conserving surgery and SLNB in Ruijin Hospital increased in last 10 years. Patients had more than 93% of 5-year OS with modern treatment modality of breast cancer, which could indicate clinical management and research in future.
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