The Research To Dangerous Factors Of Relapse Or Metastasis After The Operation To Women's Breast Cancer

Objective(s) Breast cancer is currently one of the most serious cancer of highest incidence among women. With the improvement of modern treatment technology , overall survival of patients after breast cancer have been significantly improved, but recurrence and metastasis of breast cancer is still the major cause of death. Through analyzing clinical and pathological factors, especially the expressional level of sex hormones and the recurrence of breast cancer and (or) metastasis, this paper is to investigate the risk factors of the recurrence of breast cancer and (or) transformation, and thus make individualized treatment programs for the clinical development and lower the recurrence of breast cancer and transformation and provide the scientific basis of the patients'life quality and the period of survival.Subject(s) and method(s) The subjects selected from January 2001 to December 2006 in the first hospital in Qinhuangdao City, Qinhuangdao City Medical Oncology Institute does modified radical mastectomy or breast-conserving surgery and after the surgery, among the female patients of breast cancer is confirmed by pathology with complete deta . 150 patients who recur after 3 years and (or) transfer is selected as a case group. While 300 patients after sursury without recurrence in 3 year or the suvival of metastasis is selected as a control group, and all subjects were excluded from liver, kidney disease, endocrine diseases and mental illness, breast cancer or the other tumor diseases. The diagnose of breast cancer and recurrent or metastatic of breast cancer was based on "breast cancer treatment guidelines and norms" of the 2007 Chinese Anti-Cancer Association of Professional Committee . Through the medical records or subjects (or relatives) , the paper is tocollect the general situation of two groups of subjects and the age at initial treatment surgery, a family history of cancer disease, whether menopause, the size of primary tumor, the status of lymph node, the types of histologic, postoperative adjuvant chemotherapy and endocrine therapy and so on; Immunohistochemistry is used to detect the situation of estrogen receptor (ER), progesterone receptor (PR), C-erbB-2 and p53 of patients. chemical luminescence immunoassay method is used to detect serum estradiol (E2), progesterone (P) and testosterone (T) level.After the check of all the information, organization, and uniform coding, Excel2003 was used to establish a database and SPSS 16.0 was used for univariate analysis and multivariate non-conditional Logistic regression analysis.Result(s) 1 The general situation of two groups of subjects(1) 150 patients were selected for cases and 300 for control. the age,educational level, occupation, nationality, marital status and other factors were compared, the difference is not statistically significant.(2) The shortest time that the subjects who relapsed after surgery and (or) transfer was 4 months; Recurrence and (or) transfer (69.33%) often occur after more than three years in 2 to 3 years. Recurrence sites were often seen in common chest wall, the site of transfer is commonly seen in the bone metastases.2 the univariate analysis of the risk factors of breast cancer recurrence and (or) transfer(1) the proportion of patients whose age is lower or equal to 40 years at the beginning of sursury or the patients who are in menopause are higher than that of the control, the difference is statistically significant (age at the beginning of surgery:χ~2 = 9.026, P<0.05; Menstrual status:χ~2 = 4.841, P<0.05), which shows that the patients in the age of (≤40) at the beginning of surgery or in menopause is of high risk which is 1.830 times of that of patients whose age is higher 40 years or 1.557 times of that of patients in menopause. A family history of cancer and breast cancer recurrence and (or) transfer may be related (χ~2 = 1.298, P> 0.05). (2) the proportion of patients of the tumor diameter >2.0cm in the Case group, lymph node metastasis before sursury, pathological type being non-invasive cancer are higher than that of the control group. The difference is statistically significant (the size of primary tumor:χ~2 = 9.818, P<0.05; lymph node metastasis:χ~2 = 12.042, P<0.05; histological pathology:χ~2 = 7.475, P<0.05). The results showed that patients of tumor size> 2.0cm, preoperative lymph node metastasis, tumor histology, pathological type being non-specific type of invasive cancer is of high risk of recurrence and metastasis, which is respectively 1.885, 1.734, 2.015 times of tumor diameter≤2.0cm, preoperative lymph node metastasis, pathological type of tumor histological type of invasive cancer.(3) The situation of two sets of staging, the difference is statistically significant (χ~2 = 7.515, P<0.05). Patients in the StageⅡ,Ⅲwith the risk of recurrence and (or) transfer are 1.898, 2.188 times of that in the stageⅠ.The difference in the postoperative adjuvant chemotherapy was no significant in the case, suggesting that breast cancer recurrence (or) transfer after adjuvant chemotherapy may be related (χ~2 = 1.313, P>0.05); the case of the two groups of endocrine therapy is significant(χ~2 = 7.515, P<0.05). The risk of recurrence and (or) metastasis for not to endocrine therapy and endocrine therapy less than those 3 years is higher than that of those less than 3 to 5 years. OR values were 2.394 and 2.004.(4) ER, PR-negative, C-erbB2-positive ratio in the case group was higher than control,which is significant (ER:χ~2 = 4.569, P<0.05, PR:χ~2=4.557,P<0.05,C-erbB2:χ~2=7.875,P<0.05). the risk of recurrence and (or) transfer are 1.535, 1.620, 1.758 times of that of ER-positive, PR positive, C-erbB2 negative of patients.(5) E2 levels is high and the risk(χ~2 = 13.018, P<0.05) of recurrence and (or) metastasis is 2.071 times of that of below or normal E2 levels. Respectively menopausal status and ER and PR status stratification, we found that both pre-menopausal or postmenopausal, E2 increased the risk of recurrence of breast cancer patients, before menopause, OR=1.969 (OR95%CI:1.145～3.386); after menopause,OR=2.168 (OR95%CI:1.198～3.927).When ER (-) and PR (-), E2 levels was not related to breast cancer recurrence and (or) transfer (OR=1.516, P>0.05). But in the ER and/or PR (+), E2 levels was related to breast cancer recurrence and (or) metastasis (OR=2.685, P <0.05). P level was not related to breast cancer recurrence and (or) transfer(χ~2=0.388,P>0.05). Stratification by ER and PR status, the result is true. But after stratification by menopausal status, we found that T increased postmenopausal breast cancer which can increase the risk of relapse and (or) transfer.3 Multivariate analysis showed that: tumor diameter>2.0cm, preoperative lymph node metastasis, ER-negative, E2 levels increased breast cancer recurrence and (or) transfer. OR values were 1.105, 1.710, 2.170, 2.534 respectively.Conclusion(s) 1 The related risk factors of breast cancer recurrence and (or) transfer may be: age at initial treatment surgery≤40 years old, premenopausal disease, tumor size>2.0cm, lymph node metastasis before surgery, pathological staging for the PhaseⅡorⅡ, pathological type of non-special type of invasive cancer, endocrine therapy after surgery not being the line specifications, estrogen receptor negative, progesterone receptor-negative, C-erbB2 expression being positive in estradiol levels, high testosterone levels.2 Tumor diameter>2.0cm, preoperative lymph node metastasis, estrogen receptor-negative, estrogen levels and other factors may be breast cancer recurrence and (or) transfer of the independent risk factors.3 E2 levels may rise when both in the pre-menopausal or postmenopausal, ER and/or PR (+) that could cause breast cancer recurrence and (or) higher risk of metastasis; after menopause, testosterone levels rise, the risk of breast cancer recurrence and (or) transfer may be increased.