發(fā)布時間：2018-06-14 10:43

  本文選題：乳腺癌 + 老年女性　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:總結(jié)和分析老年女性乳腺癌患者的臨床病理特征、治療方式及預(yù)后等,并與國內(nèi)外相關(guān)研究結(jié)果進行對比研究,同時探討影響老年女性乳腺癌患者預(yù)后的因素,為老年女性乳腺癌的規(guī)范化和個體化治療提供理論依據(jù)。方法:1回顧性分析自2009年1月至2015年12月河北省乳腺中心收治的1144例老年女性(年齡"g65)原發(fā)性乳腺癌患者的臨床病理資料,并分為65-70歲及70歲以上年齡組進行臨床病理特征、治療現(xiàn)狀及預(yù)后等方面的對比分析;對從2009年1月至2011年12月收治的382例原發(fā)性老年乳腺癌患者進行隨訪,應(yīng)用總生存率(OS)及無病生存率(DFS)進行預(yù)后評價,分析影響老年女性乳腺癌患者的預(yù)后因素。2應(yīng)用SPSS21.0統(tǒng)計軟件進行數(shù)據(jù)分析。不同年齡組患者間的一般資料、臨床病理特征、分子生物學(xué)指標及治療方式等的比較采用χ2檢驗或Fisher確切概率法;應(yīng)用Kaplan-Meier法進行單因素生存分析,組間比較采用Log-rank檢驗,多因素分析采用Cox風(fēng)險比例模型。以P0.05為差異具有統(tǒng)計學(xué)意義。結(jié)果:1老年女性乳腺癌患者絕大多數(shù)(94.2%)是以乳房腫物為首發(fā)癥狀。浸潤性導(dǎo)管癌是老年女性乳腺癌患者最常見的病理類型,預(yù)后較好的病理類型浸潤性小葉癌、粘液腺癌在高齡組患者的比例相對偏高。老年乳腺癌患者就診時腫瘤直徑偏大,疾病分期以T1-2期為主,腋窩淋巴結(jié)轉(zhuǎn)移陽性率為37.8%,且以1-3個淋巴結(jié)轉(zhuǎn)移多見。老年乳腺癌患者具有較好的分子生物學(xué)指標:ER陽性率為71.9%,PR陽性率63.3%,Ki-67高表達及HER-2陽性比例低,腫瘤分化級別低。2手術(shù)治療是老年乳腺癌患者的主要治療方式,改良根治術(shù)為最常見的術(shù)式(78.7%),保乳手術(shù)比例相對年輕人及西方數(shù)據(jù)偏低。術(shù)后輔助治療中,化療及放療比例均相對偏低,內(nèi)分泌治療是術(shù)后輔助治療的主要手段之一,共773例(67.6%)患者接受內(nèi)分泌治療。3在382例完整隨訪患者中,中位隨訪時間是64個月,5年總生存率OS為86.6%,其中64例患者出現(xiàn)死亡,41例死于乳腺癌。5年的無病生存率DFS是83.2%,74例患者出現(xiàn)遠處轉(zhuǎn)移或局部復(fù)發(fā)。單因素及多因素分析顯示年齡和腫瘤直徑是影響老年乳腺癌患者OS的獨立預(yù)后因素,影響DFS的獨立預(yù)后因素是腫瘤直徑。結(jié)論:老年乳腺癌患者相對于青年人群具有更好的病理學(xué)特征及分子生物學(xué)指標,治療方式上手術(shù)治療及術(shù)后輔助內(nèi)分泌治療更常見,輔助化療及放療比例明顯偏低,年齡和腫瘤直徑是影響老年女性乳腺癌患者OS的獨立預(yù)后因素,70歲以下組患者的5年OS優(yōu)于70歲以上組患者。
[Abstract]:Objective: to summarize and analyze the clinicopathological features, treatment methods and prognosis of elderly women with breast cancer, and to compare the results with those of other related studies at home and abroad, and to explore the factors influencing the prognosis of elderly women with breast cancer. To provide theoretical basis for standardization and individualized treatment of breast cancer in elderly women. Methods from January 2009 to December 2015, the clinicopathological data of 1144 elderly women (g65) with primary breast cancer were retrospectively analyzed and divided into the age group of 65 to 70 years old and the age group over 70 years old. From January 2009 to December 2011, 382 cases of primary elderly breast cancer were followed up, and the overall survival rate (OS) and disease-free survival rate (DFS) were evaluated. The prognostic factors of elderly women with breast cancer were analyzed by SPSS 21.0 statistical software. The general data, clinicopathological features, molecular biological parameters and treatment methods were compared by 蠂 2 test or Fisher exact probability method, Kaplan-Meier method was used for univariate survival analysis, and Log-rank test was used for the comparison between groups. Cox risk proportional model was used for multivariate analysis. P0.05 as the difference was statistically significant. Results the breast mass was the first symptom in the majority of female breast cancer patients. Invasive ductal carcinoma is the most common pathological type in elderly women with breast cancer. The prognosis of invasive lobular carcinoma is better. The proportion of mucinous adenocarcinoma in the elderly patients is relatively high. The tumor diameter was larger in the elderly patients with breast cancer. The stage of the disease was mainly T1-2. The positive rate of axillary lymph node metastasis was 37.8 and 1-3 lymph node metastases were more common. The positive rate of 71.9% PR and 63.3% Ki-67 and HER-2 positive rate were 63.3% and 63.3% respectively in the elderly patients with breast cancer. The low differentiation grade of tumor was the main treatment method for the elderly breast cancer patients. Modified radical mastectomy was the most common operation, and the proportion of breast conserving surgery was lower than that of young people and western countries. In postoperative adjuvant therapy, the proportion of chemotherapy and radiotherapy was relatively low. Endocrine therapy was one of the main methods of postoperative adjuvant therapy. The median follow-up time was 64 months, and the overall 5-year survival rate was 86.6%. Among them, 41 cases died of breast cancer in 64 cases, and the 5-year disease-free survival rate (DFS) was 83.22.74 cases with distant metastasis or local recurrence. Univariate and multivariate analysis showed that age and tumor diameter were independent prognostic factors of OS in elderly patients with breast cancer, and tumor diameter was the independent prognostic factor of DFS. Conclusion: elderly patients with breast cancer have better pathological characteristics and molecular biological indexes than young people. Surgical treatment and postoperative adjuvant endocrine therapy are more common than young people, and the proportion of adjuvant chemotherapy and radiotherapy is obviously low. Age and tumor diameter were independent prognostic factors of OS in elderly women with breast cancer. The 5-year OS of patients under 70 years old was better than that of patients over 70 years old.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.9

【參考文獻】

相關(guān)期刊論文 前1條

1 趙衛(wèi)紅;徐兵河;李青;張頻;孫燕;;70歲以上老年女性乳腺癌患者的特點和預(yù)后分析[J];中華腫瘤雜志;2006年05期

，

本文編號：2017112