Diagnosis, treatment and survival of breast cancer patients in single large hospital: a 10-year analysis

doi:10.16139/j.1007-9610.2021.02.012

Abstract

Abstract:

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.

Key words: Breast cancer, Overall survival rate, Disease free survival rate, Breast conserving surgery, Sentinel lymph node biopsy

CLC Number:

R737.9

CHEN Xiaosong, LI Shuai, WU Jiayi, HUANG Ou, CHAI Weimin, YAO Jiejie, ZHU Ying, XU Chen, CHEN Jiayi, QU Qing, FEI Xiaochun, DING Xiaoyi, LIN Lin, ZHANG Nan, FANG Qiong, HE Jianrong, ZHU Li, LI Yafen, CHEN Weiguo, SHEN Kunwei. Diagnosis, treatment and survival of breast cancer patients in single large hospital: a 10-year analysis[J]. Journal of Surgery Concepts & Practice, 2021, 26(02): 149-158.

Figures/Tables 10

特征	病例	比例（%）	特征	病例	比例（%）
总体	8 210	100.0	组织学类型
年份			包裹性乳头状癌	19	0.2
2009	382	4.7	其他	206	2.5
2010	543	6.6	未知	5	0.1
2011	610	7.4	肿瘤大小^c）
2012	694	8.5	Tis	959	12.7
2013	701	8.5	T₁	3 886	51.5
2014	870	10.6	T₂	2 398	31.8
2015	953	11.6	T_3/4	129	1.7
2016	1 054	12.8	T_x	177	2.3
2017	1 164	14.2	淋巴结状态^c）
2018	1 239	15.1	N₀	5 379	71.3
年龄（岁）^a）			N₁	1 391	18.4
≤34	381	4.6	N₂	481	6.4
35~44	1 367	16.7	N₃	298	3.9
45~54	2 355	28.7	TNM分期^c）
55~64	2 272	27.7	0	949	12.6
65~74	1 251	15.2	Ⅰ	2 964	39.3
≥75	584	7.1	ⅡA	1 944	25.8
性别			ⅡB	687	9.1
女	8 166	99.5	Ⅲ	819	10.8
男	44	0.5	未知	186	2.4
月经状态			肿瘤等级^c）
绝经前/围绝经期^b）	3 353	40.8	Ⅰ	635	8.4
绝经后	4 815	58.6	Ⅱ	3 618	47.9
未知	42	0.5	Ⅲ	2 422	32.1
恶性肿瘤既往史			未知	874	11.6
否	7 863	95.8	淋巴血管侵犯
是	344	4.2	阴性	7 551	92.0
未知	3	0.0	阳性	659	8.0
乳腺癌家族史			ER状态^d）
否	7 682	93.6	阴性	2 284	27.8
是	523	6.4	阳性	5 839	71.1
未知	5	0.1	未知	87	1.1
组织学类型			PR状态^e）
浸润性导管癌	5 480	66.6	阴性	3 283	40.0
导管原位癌	844	10.6	阳性	4 840	58.9
黏液腺癌	277	3.4	未知	87	1.1
导管原位癌伴微浸润	757	9.2	HER2状态
浸润性小叶癌	206	2.5	阴性	5 348	65.1
实性乳头状癌	27	0.3	阳性	1 925	23.5
实性乳头状癌伴微浸润	10	0.1	未知	937	11.4
浸润性实性乳头状癌	62	0.8	Ki67水平^f）
导管内乳头状癌	36	0.5	≤14%	3 007	36.6
导管内乳头状癌伴微浸润	10	0.1	>14%	5 103	62.2
浸润性导管内乳头状癌	16	0.2	未知	100	1.2
化生性癌	59	0.7	分子分型
大汗腺癌	49	0.6	Luminal A型	1 826	22.2
浸润性微乳头状癌	41	0.5	Luminal B/HER2-型	2 566	31.3
小叶原位癌	38	0.5	Luminal B/HER2+型	880	10.7
髓样癌	25	0.3	HER2扩增型	1 044	12.7
浸润性乳头状癌	24	0.3	TNBC	918	11.2
伴神经分化特征的癌	19	0.2	未知	976	11.9

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特征	病例	比例(%)	中位随访（IQR）（月）	事件数	5年DFS率（95%CI）	10年DFS率（95%CI）	P值
总体	8 210		44.0(22.0~73.0)	878	87.6(86.8~88.4)	80.5(78.7~82.3)
新辅助治疗							<0.001
否	7 549	91.9	41.0(20.0~66.0)	689	89.2(88.4~90.0)	81.8(79.6~84.0)
是	661	8.1	44.0(23.0~73.0)	189	69.8(65.9~73.7)	60.8(54.9~66.7)
乳房手术方式							<0.001
保乳手术	2 377	29.0	41.0(20.0~66.0)	187	89.6(88.0~91.2)	83.5(80.6~86.4)
乳房切除	5 833	71.0	45.0(23.0~77.0)	691	86.8(85.8~87.8)	78.9(76.5~81.3)
TNM分期^a）							<0.001
0	949	12.9	41.0(22.0~70.0)	42	94.9(93.1~96.7)	90.7(86.8~94.6)
Ⅰ	2 964	40.3	46.0(23.0~75.0)	179	92.8(91.6~94.0)	86.4(83.1~89.7)
ⅡA	1 944	26.4	45.0(23.0~75.0)	196	88.3(86.5~90.1)	81.9(79.2~84.6)
ⅡB	687	9.3	41.0(21.0~70.0)	90	85.1(82.0~88.2)	74.9(68.8~81.0)
Ⅲ	819	11.1	35.0(18.0~62.0)	166	75.5(72.0~79.0)	64.9(58.0~71.8)

特征	病例	比例(%)	中位随访（IQR）（月）	事件数	5年OS率（95% CI）	10年OS率（95% CI）	P值
总体	82 10		46.0(25.0~76.0)	394	94.2(93.6~94.8)	90.7(89.7~91.7)
新辅助治疗							<0.001
否	7 549	91.9	46.0(24.0~76.0)	286	95.5(94.9~96.1)	90.7(88.9~92.5)
是	661	8.1	48.0(28.0~73.0)	108	81.1(77.6~84.6)	75.7(71.2~80.2)
乳房手术方式							<0.001
保乳手术	2 377	29.0	45.0(22.0~70.0)	62	96.5(95.5~97.5)	93.0(90.0~96.0)
乳房切除	5 833	71.0	47.0(26.0~79.0)	332	93.3(92.5~94.1)	88.2(86.4~90.0)
TNM分期^a）							<0.001
0	949	12.9	43.0(23.0~71.0)	10	98.7(97.7~99.7)	97.2(94.8~99.6)
Ⅰ	2 964	40.3	47.0(25.0~77.0)	64	97.5(96.7~98.3)	94.7(92.9~96.5)
ⅡA	1 944	26.4	47.0(26.0~78.0)	78	95.7(94.5~96.9)	89.5(85.4~93.6)
ⅡB	687	9.3	47.0(24.0~71.0)	41	92.6(90.1~95.1)	86.4(81.7~91.1)
Ⅲ	819	11.1	43.0(21.0~72.0)	90	85.6(82.5~88.7)	71.8(61.2~82.4)

特征	病例	比例(%)	中位随访（IQR）（月）	事件数	5年DFS率（95%CI）	10年DFS率（95%CI）	P值
总体	3 800		76.0(60.0~95.0)	625	86.9(85.7~88.1)	79.1(76.9~81.3)
新辅助治疗							<0.001
否	3 437	90.4	77.0(60.0~95.0)	496	88.8(87.8~89.8)	81.4(79.2~83.6)
是	363	9.6	64.0(35.0~88.0)	129	68.6(63.7~73.5)	59.7(53.2~66.2)
乳房手术方式							0.039
保乳手术	1 003	26.4	72.0(59.0~87.0)	139	88.5(86.5~90.5)	82.5(79.4~85.6)
乳房切除	2 797	73.6	78.0(60.0~97.0)	486	86.3(84.9~87.7)	78.4(76.0~80.8)
TNM分期^a）							<0.001
0	380	11.4	77.0(63.0~94.0)	26	95.0(92.8~97.2)	89.2(84.1~94.3)
Ⅰ	1 333	40.1	79.0(62.0~96.0)	139	92.1(90.7~93.5)	85.8(82.3~89.3)
ⅡA	894	26.9	78.0(61.0~95.0)	137	88.5(86.3~90.7)	82.1(79.1~85.1)
ⅡB	323	9.7	71.0(57.0~90.0)	64	84.7(80.8~88.6)	74.6(68.3~80.9)
Ⅲ	393	11.8	69.0(52.0~91.0)	119	74.7(70.4~79.1)	64.2(57.1~71.3)

特征	病例	比例(%)	中位随访（IQR）（月）	事件数	5年OS率（95%CI）	10年OS率（95%CI）	P值
总体	3 800		79.0（62.0-97.0）	335	93.1（92.3~93.9）	88.4（86.8~90.0）
新辅助治疗							<0.001
否	3 437	90.6	80.0（63.0-97.0）	250	94.6（93.8~95.4）	89.8（88.0~91.6）
是	363	9.4	71.0（53.0-93.0）	85	79.4（75.3~83.5）	74.1（69.0~79.2）
乳房手术方式							<0.001
保乳手术	1 003	26.4	74.0（61.0-90.0）	52	95.9（94.7~97.1）	92.4（89.3~95.5）
乳房切除	2 797	73.6	81.0（62.0-99.0）	283	92.1（91.1~93.1）	87.1（85.1~89.1）
TNM分期^a）							<0.001
0	380	11.4	79.0(65.0-96.0)	7	98.7（97.5~99.9）	97.1（94.7~99.5）
Ⅰ	1 333	40.1	81.0(65.0-98.0)	60	96.8（95.8~97.8）	94.0（92.2~94.0）
ⅡA	894	26.9	81.0(64.0-97.0)	67	94.8（93.4~96.2）	88.8（84.5~93.1）
ⅡB	323	9.7	73.0(59.0-93.0)	35	92.1（89.2~95.0）	85.9（81.0~90.8）
Ⅲ	393	11.8	74.0(58.0-94.0)	78	83.3（79.6~87.0）	69.8（59.4~80.2）