| Objective:Breast cancer is a systemic disease of the new concept, replacing the old concept that,breast cancer is a local disease,born out of a comprehensive treatment modalities of breast cancer.In addition, when stress the comprehensive treatment of breast cancer we should also take into account individual treatment, while the choice of individual treatment is based on the different to make an accurate assessment of the prognosis of patients and thus to guide clinicians according to different prognostic factors in patients with a more optimal choice of treatment , for the prevention of postoperative recurrence and metastasis as early as possible to make a useful exploration. Based on standardized comprehensive treatment based on individual treatment, will become the future direction for the treatment of breast cancer. In this paper, 680 cases of breast cancer patients after combined therapy were reviewed, applied Cox proportional hazard model to analyse the influence of clinicopathologic features and comprehensive treatment about breast cancer prognosis.Methods: This study collected the Fourth Hospital of Hebei Medical University, Department of Medical Oncology during the March 1, 2007 to 2008, October 31 cases,which are admitted to a clear pathological diagnosis of breast cancer surgery cases, the establishment of clinical data in patients with Access database, excluding the cases of distant metastasis breast cancer, received a total of 680 cases of surgical patient data, including 191 cases of patients with recurrence and metastasis, disease-free survival of patients with 489 cases. All patients were followed up on (telephone and out-patient follow-up review).The follow-up period ended December 31, 2009, or death, lost to date. Patient operative time as a starting point, to patient death, loss of follow-up visit or last time for end. OS (overall survival) means from diagnosis until death or for any reason, the end of the last follow-up time. DFS (disease-free survival) means from the beginning to the diagnosis to the end of recurrence and metastasis of any part of the time. MSR (post metastasis survival) refers the first time in any part of the recurrence and metastasis to death or for any reason, the end of the last follow-up time. All the follow-up data will be proofread and correct input SPSS13.0 statistical software of statistical analysis. Reference to relevant research at home and abroad, and combined with clinical practice situation, age, tumor size, axillary lymph node metastasis and other clinicopathological features and the adjuvant treatment methods to quantify the integrated assignment, using Cox proportional hazard model analysis, come to affect the breast cancer surgery After the patients disease-free survival (DFS) and overall survival (OS) of the independent prognostic factors. In addition to the first recurrence and metastasis as a starting point to further affect the 191 cases of recurrent and metastatic breast cancer survival analysis of prognostic factors in Cox. All analyses were performed by using SPSS13.0 software package.Chi-square test was used for the enumeration data to comparison, the survival rate calculated using Kaplan-Meier method (Kaplan-Meier), applied between the two groups Log-rank test. and the univariate and multivariate analysis of these individual variables were performed by Cox proportional hazard model.All tests were performed at the 0.05 level of significances.Results:1 The survival situation: the whole group 1,2,3-year overall survival rate in patients with 99.3%, 95.6%, 90.8%; the whole group 1,2,3-year disease-free survival rate was 92.5%, 83.5%, 68.3%; the 1,2,3 year survival rates after relapse of recurrence and metastasis of 191 cases were 77.7% and 58.1%, 51.4%.2 For different lymph node dissection conducted by comparing the rate of lymph node metastasis showed that the number of lymph node dissection≦ 10, low rate of lymph node metastasis, whereas when lymph node dissection >10 ,the rate of lymph node metastasis is high (P <0.05), there are statistics significance.3 On univariate analysis of DFS: tumor size, number of axillary lymph node metastasis, ER, PR expression, HER-2 expression, adjuvant chemotherapy cycles, adjuvant chemotherapy and adjuvant endocrine treatment, adjuvant radiotherapy of breast cancer affecting DFS (P <0.05). Multivariate analysis showed: clinical stage, adjuvant chemotherapy and ER, PR expression are the independent prognostic factors affecting DFS (P <0.05).4 On univariate analysis of OS: tumor size, number of axillary lymph node metastasis, ER, PR expression, HER-2 expression, adjuvant endocrine treatment of breast cancer affecting OS(P<0.05). Multivariate analysis showed that: the number of axillary lymph node metastasis and adjuvant endocrine therapy were independent prognostic factors. (P <0.05).5 On 191 cases of recurrent and metastatic breast cancer prognosis univariate analysis showed that: the number of axillary lymph node metastasis, the first site of recurrence and metastasis and adjuvant endocrine therapy were independent prognostic factors. (P <0.05). Multivariate analysis showed that: the number of axillary lymph node metastasis, the first site of recurrence and metastasis and adjuvant endocrine therapy of breast cancer are also or the independent prognostic factor of MSR (P <0.05).6 Taxanes compared with anthracyclines can significantly prolong the whole group of patients with DFS (P<0.05). Subgroup analysis showed: taxanes can benefit the HER-2+++/hormone receptor double negative / the number of axillary lymph node positive≧ 4 patients absolutely (P <0.05).7 Adjuvant hormonal therapy compared with without endocrine therapy group can significantly prolong the whole group of patients with DFS (P<0.05). Stratified analysis showed: hormone receptor-positive, HER-2-/+ patients can benefit more from adjuvant endocrine therapy (P<0.05). The single hormone receptor-positive patients with endocrine therapy have an extension of its DFS trend, but no statistical significance (P >0.05); of hormone receptor double negative patients can not benefit from endocrine therapy(P >0.05). For hormone receptor-positive patients, endocrine therapy can benefit older than 35 years of age / pre-menopausal / axillary lymph node-negative patients absolutely(P <0.05).Conclusion:1 The independent prognostic factors of disease-free survival (DFS)are: clinical stage, adjuvant chemotherapy, as well as ER, PR expression.2 The independent prognostic factors of overall survival (OS) are: the number of axillary lymph node positive and adjuvant endocrine therapy. The less the number of lymph node dissection ,the lower lymph node metastasis positive rates , which affecting the prognosis of patients for postoperative evaluation and treatment.3 The independent factors of (MSR) are the sites of metastatic, the number of axillary lymph node positive and adjuvant endocrine therapy. The first metastatic site is local recurrence with distant metastasis in patients possesses the worst prognosis.4 HER-2(+++)/ hormone receptor double-negative/ the number of axillar-y lymph node metastases≧ 4 in the patients were the advantaged crowd of taxanes in early breast cancer.5 Hormone receptor-positive, HER-2-/+ patients may benefit from end-ocrine therapy to survive. Of hormone receptor-positive patients, endocri-ne therapy can enable the age of "35-year-old patient or pre-menopausalpatient or axillary lymph node-negative patients with an absolute benefit. |
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