Study on adjuvant chemotherapy of luminal A type breast cancer based on Surveillance, Epidemiology and End Results Database
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摘要:目的 基于美国国立癌症研究所（NCI）的监测、流行病学和结果数据库（SEER数据库）观察管腔（Luminal）A型早期乳腺癌辅助化疗的临床疗效。方法 应用SEER数据库筛选出207 404例接受过手术治疗的Luminal A型早期乳腺癌患者的资料，根据是否接受辅助化疗将患者分为化疗组与未化疗组，并根据临床病理特征进行亚组分型。比较2组患者的生存时间与累积风险曲线。结果 Luminal A型早期乳腺癌患者总体预后良好，患者性别、年龄、种族、病理类型以及病理分级对Luminal A型早期乳腺癌化疗决策的影响不大，而临床分期、淋巴结转移N分期对患者的化疗决策有一定影响。结论 在缺乏多基因检测结果的情况下，临床工作中可考虑将淋巴结转移N1mi期纳入Luminal A型早期乳腺癌患者免除辅助化疗的参考指标。
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关键词:
- 美国国立癌症研究所 /
- 监测、流行病学和结果数据库 /
- 乳腺癌 /
- 管腔A型 /
- 化疗
Abstract:Objective To observe the clinical efficacy of adjuvant chemotherapy for Luminal A early breast cancer based on the Surveillance, Epidemiology and End Results (SEER) Database of National Cancer Institute(NCI).Methods Using the SEER database, 207 404 cases of Luminal A type breast cancer who had received surgeries at early stage were screened out, and they were divided into chemotherapy group and non-chemotherapy group according to whether applying adjuvant chemotherapy or not, and subtype classification was performed according to clinicopathological characteristics. The cumulative risk curve and survival time of the two groups were compared.Results Luminal A type early breast cancer patients had good overall prognosis, and it was found that the patient's gender, age, race, pathological type, and pathological grade had limited influence on the chemotherapy decision-making of Luminal A type early breast cancer. However, clinical grade and lymph node metastasis N staging had important impacts for chemotherapy decisions.Conclusion In clinical work, the N1mi staging of lymph node metastasis can be considered as a clinical reference index for patients with Luminal A early breast cancer to avoid adjuvant chemotherapy in the absence of polygenic test results. -
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图 1 化疗组与未化疗组的累积风险曲线图
A: 整体累积风险曲线; B: ⅡB期患者的累积风险曲线; C: N1mi期患者的累积风险曲线; D: N1a、N1b、N1c期患者的累积风险曲线。
表 1 2组人口学资料、临床特征及其K-M生存分析结果[n(%)]
指标 未化疗组(n=158 683) 化疗组(n=48 721) P K-M生存分析结果 χ2 P 临床分期 0期、ⅠA期 115 625(72.87) 13 789(28.30) <0.001 93.766 <0.001 ⅠB期 4 139(2.61) 2 120(4.35) 9.159 0.002 ⅡA期 29 677(18.70) 18 639(38.26) <0.001 0.984 ⅡB期 9 242(58.26) 14 173(29.09) 6.513 0.011 腋窝淋巴结转移N分期 N0期 140 809(88.74) 25 292(51.91) <0.001 284.462 <0.001 N1mi期 6 028(3.80) 4 152(8.52) 27.769 <0.001 N1a、N1b、N1c期 10 989(6.93) 16 510(33.89) 20.968 <0.001 肿瘤长径T分期 T0~T1期 126 188(79.52) 24 498(50.28) <0.001 164.910 <0.001 T2期 30 564(19.26) 22 770(46.74) 16.040 <0.001 T3期 1 931(1.22) 1 453(2.98) 0.040 0.841 性别 女 157 471(99.24) 48 307(99.15) 0.060 529.489 <0.001 男 1 212(0.76) 414(0.85) 0.205 0.651 年龄 15~<40岁 2 138(1.35) 4 060(8.33) <0.001 37.170 <0.001 40~<55岁 31 769(20.02) 19 845(40.73) 297.627 <0.001 55~<70岁 65 013(40.97) 20 459(41.99) 411.316 <0.001 ≥70岁 59 763(37.66) 4 357(8.94) 73.142 <0.001 病理分级 Ⅰ级 59 335(37.40) 6 726(13.81) <0.001 6.770 0.009 Ⅱ级 78 089(49.21) 22 595(46.38) 72.978 <0.001 Ⅲ级 17 048(10.74) 18 185(37.32) 10.211 0.001 合计 158 683(100.00) 48 721(100.00) — 524.790 <0.001 腋窝淋巴结转移N分期、病理分级中未列出数据库缺失数据。 
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