北京地區(qū)一項(xiàng)單中心乳腺癌主要流行病學(xué)指標(biāo)演變趨勢的研究（2000-2015年）
發(fā)布時(shí)間：2018-08-21 20:00
【摘要】：目的近十幾年來我國居民的癌癥發(fā)病率總體呈現(xiàn)上升趨勢。其中,乳腺癌是我國女性最主要的惡性腫瘤之一,發(fā)病率位居首位,死亡率僅次于肺癌、結(jié)直腸癌、胃癌,位居第四位,嚴(yán)重危害我國女性的生命健康。乳腺癌的發(fā)病具有城鄉(xiāng)差別,城市地區(qū)乳腺癌發(fā)病率較高,農(nóng)村地區(qū)乳腺癌死亡率較高[1,2]。國內(nèi)已有不少關(guān)于乳腺癌流行病學(xué)的相關(guān)報(bào)道[3-5],但乳腺癌的流行病學(xué)特征,如發(fā)病年齡分布、臨床分期等,可能隨著時(shí)間的改變、篩查的逐步開展以及診斷技術(shù)的提高等因素而發(fā)生改變。針對我國乳腺癌流行病學(xué)隨時(shí)間的動(dòng)態(tài)演變趨勢的研究極少,缺乏相關(guān)的大樣本數(shù)據(jù)。本研究旨在分析2000.01.01~2015.12.31期間,初治且在我院手術(shù)的原發(fā)性女性乳腺癌的主要流行病學(xué)特征(發(fā)病年齡、臨床分期和分子分型)的變化趨勢,為乳腺癌的預(yù)防、篩查提供更為科學(xué)的依據(jù)。方法從軍事醫(yī)學(xué)科學(xué)院附屬醫(yī)院(解放軍307醫(yī)院)病案室電子病例檔案庫中,收集2000.01.01~2015.12.31期間,初治且在我院手術(shù)的原發(fā)性女性乳腺癌患者資料2482例。組織學(xué)分類參照2003年世界衛(wèi)生組織(World Health Organization,WHO)乳腺腫瘤組織學(xué)分類;TNM分期參照2010年美國癌癥聯(lián)合委員會(huì)(American Joint Committee on Cancer,AJCC)乳腺癌TNM分期[6];分子分型參照2013年ST Gallen共識,分為Luminal型(Luminal A型+Luminal B型)、三陰型、HER2過表達(dá)型。運(yùn)用Excel 2013進(jìn)行乳腺癌相關(guān)數(shù)據(jù)錄入和圖表繪制,建立數(shù)據(jù)庫,回顧性分析乳腺癌患者發(fā)病年齡、臨床分期和分子分型的總體分布特征及其隨年代變化的趨勢。統(tǒng)計(jì)分析采用SAS 9.2軟件。定量資料的描述采用均數(shù)±標(biāo)準(zhǔn)差、中位數(shù)(四分位數(shù)間距),不同年份的比較采用方差分析或者Kruskal-Wallis秩和檢驗(yàn);定性資料的描述采用率或構(gòu)成比,不同年份的比較采用卡方檢驗(yàn)或Fisher精確概率法。檢驗(yàn)水平α=0.05。結(jié)果1.2482例符合條件的乳腺癌患者主要來自我國北方地區(qū)。2000~2015年間,我院乳腺癌確診人數(shù)呈逐年上升趨勢,其中2000~2005年302例,2006~2010年746例,2011~2015年1434例。2482例初治原發(fā)性乳腺癌中位確診年齡48(19~87)歲,發(fā)病高峰年齡段41~60歲(占61.04%),36~65歲年齡段的乳腺癌占81.43%。其中,2000~2005年的中位年齡為48(23~85)歲,2006~2010年的中位年齡為48(19~82)歲,2011~2015年的中位年齡為49(20~87)歲,無明顯變化趨勢,差異無統(tǒng)計(jì)學(xué)意義(P=0.0679)。2.早發(fā)性乳腺癌(35歲)共193例,占總確診人數(shù)的7.78%(193/2482)。其中2000~2005年早發(fā)性乳腺癌比率7.95%(24/302),2006~2010年早發(fā)性乳腺癌比率7.10%(53/746),2011~2015年早發(fā)性乳腺癌比率8.09%(116/1434),無明顯變化趨勢,差異無統(tǒng)計(jì)學(xué)意義(P=0.7127)。3.2482例初治原發(fā)性乳腺癌可進(jìn)行組織學(xué)分類的共2446例(98.55%),其中原位癌203例(8.30%),浸潤性乳腺癌2243例(91.70%)。2000~2005年原位癌比率2.43%(7/288),2006~2010年原位癌比率6.77%(50/739),2011~2015年原位癌比率10.29%(146/1419),隨時(shí)間上升趨勢顯著,差異具有統(tǒng)計(jì)學(xué)意義(P0.0001)。4.2482例中可進(jìn)行TNM分期的共2403例(96.81%)。其中0期乳腺癌203例,占比8.45%(203/2403);Ⅰ期乳腺癌636例,2000~2005年Ⅰ期乳腺癌比率22.30%(64/287),2006~2010年Ⅰ期乳腺癌比率23.55%(171/726),2011~2015年Ⅰ期乳腺癌比率28.83%(401/1391),上升趨勢顯著;Ⅱ期乳腺癌1025例,2000~2005年Ⅱ期乳腺癌比率45.30%(130/287),2006~2010年Ⅱ期乳腺癌比率47.52%(345/726),2011~2015年Ⅱ期乳腺癌比率39.54%(550/1391),有所下降;Ⅲ期乳腺癌449例,2000~2005年Ⅲ期乳腺癌比率26.83%(77/287),2006~2010年Ⅲ期乳腺癌比率18.04%(131/726),2011~2015年Ⅲ期乳腺癌比率17.33%(241/1391),比率呈下降趨勢;Ⅳ期乳腺癌90例,2000~2005年Ⅳ期乳腺癌比率3.14%(9/287),2006~2010年Ⅳ期乳腺癌比率3.99%(29/726),2011~2015年Ⅳ期乳腺癌比率3.74%(52/1391),比率趨勢變化平穩(wěn)。整體變化差異有統(tǒng)計(jì)學(xué)意義(P0.0001)。5.可手術(shù)早期乳腺癌(0~Ⅱ期+T3N1M0期)共1904例,占可行TNM分期乳腺癌的79.23%(1904/2403)。其中2000~2005年可手術(shù)早期乳腺癌比率73.52%(211/287),2006~2010年可手術(shù)早期乳腺癌比率80.30%(583/726),2011~2015年可手術(shù)早期乳腺癌比率79.86%(1110/1390),隨時(shí)間變化有增加趨勢,差異具有統(tǒng)計(jì)學(xué)意義(P=0.0379)。6.2482例初治原發(fā)性乳腺癌有免疫組化四項(xiàng)(ER、RP、HER2、Ki-67)的共2238例(90.17%),原位癌171例,浸潤性癌2067例。浸潤性癌中Luminal型(包括Luminal A型和Luminal B型)比率73.73%(1524/2067),三陰型比率17.42%(360/2067),HER2過表達(dá)型比率8.85%(183/2067)。2000~2005年Luminal型比率70.19%(146/208),2006~2010年Luminal型比率72.13%(458/635),2011~2015年Luminal型比率75.16%(920/1224),隨時(shí)間有上升趨勢;2000~2005年HER2過表達(dá)型比率4.33%(9/208),2006~2010年HER2過表達(dá)型比率8.50%(54/635),2011~2015年HER2過表達(dá)型比率9.80%(120/1224),隨時(shí)間有上升趨勢;2000~2005年三陰型比率25.48%(53/208),2006~2010年三陰型比率19.37%(123/635),2011~2015年三陰型比率15.03%(184/1224),隨時(shí)間有減少趨勢,整體頻數(shù)分布差異有統(tǒng)計(jì)學(xué)意義(P=0.0005)。結(jié)論1、2000~2015年,我院乳腺癌中位發(fā)病年齡近5年雖略有增加,但未發(fā)現(xiàn)明顯上升,高峰發(fā)病年齡段為41~60歲(占比61.04%),中位年齡48歲,36~65歲年齡段的乳腺癌占所有乳腺癌的81.43%,該年齡段的女性應(yīng)考慮為乳腺癌篩查的重點(diǎn)人群。2、早發(fā)性乳腺癌(35歲)發(fā)病總體穩(wěn)定,在乳腺癌中仍有8%左右的較高比例;3、可手術(shù)早期乳腺癌(0~Ⅱ期,Ⅲ期中的T3N1M0),尤其是原位癌(0期)和Ⅰ期乳腺癌比例近年來有顯著增加的趨勢,而局部晚期乳腺癌有減少的趨勢,Ⅳ期乳腺癌變化趨勢不明顯;4、浸潤性乳腺癌分子分型總體隨時(shí)間變化趨勢不大,本研究發(fā)現(xiàn)Luminal型及HER2過表達(dá)型乳腺癌有增加趨勢,Luminal型近5年比例達(dá)75%以上,是最主要的分子亞型。
[Abstract]:Objective In recent ten years, the incidence of cancer in Chinese residents has been on the rise. Breast cancer is one of the most important malignant tumors in Chinese women. The incidence of breast cancer ranks first, the mortality rate is second only to lung cancer, colorectal cancer, gastric cancer, ranking fourth, seriously endangering the lives and health of Chinese women. The incidence of breast cancer in urban areas is higher than that in rural areas [1,2]. There have been many reports on the epidemiology of breast cancer in China [3-5]. However, the epidemiological characteristics of breast cancer, such as age distribution and clinical stage, may be due to the change of time, the gradual development of screening and the improvement of diagnostic techniques. This study was designed to analyze the main epidemiological characteristics (age of onset, clinical stage and molecular typing) of primary female breast cancer, which was initially treated and operated on in our hospital from January 2000 to December 2015.31. Methods 2482 cases of primary female breast cancer were collected from the electronic case archives of the medical record room of the Affiliated Hospital of the Chinese Academy of Military Medical Sciences (307 Hospital of the PLA) from January 2000 to December 2015. According to the World Health Organization (WHO) histological classification of breast tumors, TNM staging refers to the 2010 American Joint Committee on Cancer (AJCC) TNM staging [6]; molecular typing refers to the 2013 ST Gallen consensus, divided into Luminal type (Luminal A + Luminal B), three negative, HER2 over-expression. Excel 2013 was used to input and draw maps of breast cancer related data. A database was established to retrospectively analyze the age of onset, clinical stages and molecular typing of breast cancer patients and their overall distribution characteristics. Quantile spacing), variance analysis or Kruskal-Wallis rank sum test were used for comparison in different years, and the descriptive rate or composition ratio of qualitative data was used for comparison in different years. Chi-square test or Fisher exact probability method were used for comparison in different years. From 2000 to 2005, 302 breast cancer cases, 746 cases from 2006 to 2010, 1434 cases from 2011 to 2015. 2482 cases of primary breast cancer were diagnosed at the median age of 48 (19-87), the peak age of onset was 41-60 (61.04%) and breast cancer at the age of 36-65 (81.43%). The median age from 2006 to 2010 was 48 (19-82). The median age from 2011 to 2015 was 49 (20-87). There was no significant difference (P = 0.0679). 2. There were 193 cases of early-onset breast cancer (35 years old), accounting for 7.78% (193/2482) of the total number of confirmed cases. The 10-year incidence of early-onset breast cancer was 7.10% (53/746) and 8.09% (116/1434) respectively. There was no significant change trend between 2011 and 2015 (P = 0.7127). In 2005, the ratio of carcinoma in situ was 2.43% (7/288), 2006-2010 was 6.77% (50/739), 2011-2015 was 10.29% (146/1419), and there was a significant upward trend with time (P 0.0001). 4.2482 cases (96.81%) had TNM staging, 203 cases (8.45%) had stage 0 breast cancer and 1 stage breast cancer. 636 cases of cancer, 2000-2005 stage I breast cancer rate 22.30% (64/287), 2006-2010 stage I breast cancer rate 23.55% (171/726), 2011-2015 stage I breast cancer rate 28.83% (401/1391), a significant upward trend; stage II breast cancer 1025 cases, 2000-2005 stage II breast cancer rate 45.30% (130/287), 2006-2010 stage II breast cancer rate 47.52% (345/726), 20. The proportion of stage II breast cancer was 39.54% (550/1391) from 11 to 2015, which decreased slightly; 449 cases of stage III breast cancer, 26.83% (77/287) of stage III breast cancer from 2000 to 2005, 18.04% (131/726) of stage III breast cancer from 2006 to 2010, 17.33% (241/1391) of stage III breast cancer from 2011 to 2015, the ratio showed a downward trend; 90 cases of stage IV breast cancer, stage IV breast cancer from 2000 to 2005. The cancer rate was 3.14% (9/287), the stage IV breast cancer rate was 3.99% (29/726) from 2006 to 2010, and the stage IV breast cancer rate was 3.74% (52/1391) from 2011 to 2015. The overall change was statistically significant (P 0.0001). The rate of operable early breast cancer was 73.52% (211/287) from 2000 to 2005, 80.30% (583/726) from 2006 to 2010, and 79.86% (1110/1390) from 2011 to 2015. The difference was statistically significant (P = 0.0379). 4 items of immunohistochemistry were found in 6.2482 cases of primary breast cancer. (ER, RP, HER2, Ki-67) in 2238 cases (90.17%), 171 cases of carcinoma in situ, 2067 cases of invasive carcinoma. The ratio of Luminal type (including Luminal A and Luminal B) in invasive carcinoma was 73.73% (1524/2067), the ratio of triple negative was 17.42% (360/2067), and the ratio of overexpression of HER2 was 8.85% (183/2067). The overexpression rate of HER2 was 4.33% (9/208) in 2000-2005, 8.50% (54/635) in 2006-2010, 9.80% (120/1224) in 2011-2015, and 25.48% (53/208) in 2000-2005. From 2006 to 2010, the tri-negative rate was 19.37% (123/635), and from 2011 to 2015, the tri-negative rate was 15.03% (184/1224). There was a decreasing trend with time. The overall frequency distribution was statistically significant (P = 0.0005). The incidence of early-onset breast cancer (35 years old) is generally stable, and there is still a high proportion of 8% in breast cancer. 3. Early-stage breast cancer (0-II, III stage T3N) can be operated on. In recent years, the proportion of 1M0 breast cancer, especially in situ (stage 0) and stage I breast cancer increased significantly, while the proportion of locally advanced breast cancer decreased, and the change trend of stage IV breast cancer was not obvious. 4. The molecular typing of invasive breast cancer did not change significantly with time. This study found that Luminal and HER2 overexpression breast cancer had an increasing trend. In the past 5 years, the proportion of Luminal is more than 75%, and is the most important molecular subtype.
【學(xué)位授予單位】：中國人民解放軍軍事醫(yī)學(xué)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.9
本文編號：2196204
[Abstract]:Objective In recent ten years, the incidence of cancer in Chinese residents has been on the rise. Breast cancer is one of the most important malignant tumors in Chinese women. The incidence of breast cancer ranks first, the mortality rate is second only to lung cancer, colorectal cancer, gastric cancer, ranking fourth, seriously endangering the lives and health of Chinese women. The incidence of breast cancer in urban areas is higher than that in rural areas [1,2]. There have been many reports on the epidemiology of breast cancer in China [3-5]. However, the epidemiological characteristics of breast cancer, such as age distribution and clinical stage, may be due to the change of time, the gradual development of screening and the improvement of diagnostic techniques. This study was designed to analyze the main epidemiological characteristics (age of onset, clinical stage and molecular typing) of primary female breast cancer, which was initially treated and operated on in our hospital from January 2000 to December 2015.31. Methods 2482 cases of primary female breast cancer were collected from the electronic case archives of the medical record room of the Affiliated Hospital of the Chinese Academy of Military Medical Sciences (307 Hospital of the PLA) from January 2000 to December 2015. According to the World Health Organization (WHO) histological classification of breast tumors, TNM staging refers to the 2010 American Joint Committee on Cancer (AJCC) TNM staging [6]; molecular typing refers to the 2013 ST Gallen consensus, divided into Luminal type (Luminal A + Luminal B), three negative, HER2 over-expression. Excel 2013 was used to input and draw maps of breast cancer related data. A database was established to retrospectively analyze the age of onset, clinical stages and molecular typing of breast cancer patients and their overall distribution characteristics. Quantile spacing), variance analysis or Kruskal-Wallis rank sum test were used for comparison in different years, and the descriptive rate or composition ratio of qualitative data was used for comparison in different years. Chi-square test or Fisher exact probability method were used for comparison in different years. From 2000 to 2005, 302 breast cancer cases, 746 cases from 2006 to 2010, 1434 cases from 2011 to 2015. 2482 cases of primary breast cancer were diagnosed at the median age of 48 (19-87), the peak age of onset was 41-60 (61.04%) and breast cancer at the age of 36-65 (81.43%). The median age from 2006 to 2010 was 48 (19-82). The median age from 2011 to 2015 was 49 (20-87). There was no significant difference (P = 0.0679). 2. There were 193 cases of early-onset breast cancer (35 years old), accounting for 7.78% (193/2482) of the total number of confirmed cases. The 10-year incidence of early-onset breast cancer was 7.10% (53/746) and 8.09% (116/1434) respectively. There was no significant change trend between 2011 and 2015 (P = 0.7127). In 2005, the ratio of carcinoma in situ was 2.43% (7/288), 2006-2010 was 6.77% (50/739), 2011-2015 was 10.29% (146/1419), and there was a significant upward trend with time (P 0.0001). 4.2482 cases (96.81%) had TNM staging, 203 cases (8.45%) had stage 0 breast cancer and 1 stage breast cancer. 636 cases of cancer, 2000-2005 stage I breast cancer rate 22.30% (64/287), 2006-2010 stage I breast cancer rate 23.55% (171/726), 2011-2015 stage I breast cancer rate 28.83% (401/1391), a significant upward trend; stage II breast cancer 1025 cases, 2000-2005 stage II breast cancer rate 45.30% (130/287), 2006-2010 stage II breast cancer rate 47.52% (345/726), 20. The proportion of stage II breast cancer was 39.54% (550/1391) from 11 to 2015, which decreased slightly; 449 cases of stage III breast cancer, 26.83% (77/287) of stage III breast cancer from 2000 to 2005, 18.04% (131/726) of stage III breast cancer from 2006 to 2010, 17.33% (241/1391) of stage III breast cancer from 2011 to 2015, the ratio showed a downward trend; 90 cases of stage IV breast cancer, stage IV breast cancer from 2000 to 2005. The cancer rate was 3.14% (9/287), the stage IV breast cancer rate was 3.99% (29/726) from 2006 to 2010, and the stage IV breast cancer rate was 3.74% (52/1391) from 2011 to 2015. The overall change was statistically significant (P 0.0001). The rate of operable early breast cancer was 73.52% (211/287) from 2000 to 2005, 80.30% (583/726) from 2006 to 2010, and 79.86% (1110/1390) from 2011 to 2015. The difference was statistically significant (P = 0.0379). 4 items of immunohistochemistry were found in 6.2482 cases of primary breast cancer. (ER, RP, HER2, Ki-67) in 2238 cases (90.17%), 171 cases of carcinoma in situ, 2067 cases of invasive carcinoma. The ratio of Luminal type (including Luminal A and Luminal B) in invasive carcinoma was 73.73% (1524/2067), the ratio of triple negative was 17.42% (360/2067), and the ratio of overexpression of HER2 was 8.85% (183/2067). The overexpression rate of HER2 was 4.33% (9/208) in 2000-2005, 8.50% (54/635) in 2006-2010, 9.80% (120/1224) in 2011-2015, and 25.48% (53/208) in 2000-2005. From 2006 to 2010, the tri-negative rate was 19.37% (123/635), and from 2011 to 2015, the tri-negative rate was 15.03% (184/1224). There was a decreasing trend with time. The overall frequency distribution was statistically significant (P = 0.0005). The incidence of early-onset breast cancer (35 years old) is generally stable, and there is still a high proportion of 8% in breast cancer. 3. Early-stage breast cancer (0-II, III stage T3N) can be operated on. In recent years, the proportion of 1M0 breast cancer, especially in situ (stage 0) and stage I breast cancer increased significantly, while the proportion of locally advanced breast cancer decreased, and the change trend of stage IV breast cancer was not obvious. 4. The molecular typing of invasive breast cancer did not change significantly with time. This study found that Luminal and HER2 overexpression breast cancer had an increasing trend. In the past 5 years, the proportion of Luminal is more than 75%, and is the most important molecular subtype.
【學(xué)位授予單位】：中國人民解放軍軍事醫(yī)學(xué)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.9
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