乳癌病患存活預後因子之探討-以某區域教學醫院為例

目的：主要探討乳癌病患接受治療後影響其復發與死亡的預後因子。方法：利用回溯性方式，收集某區域教學醫院外科部2000年1月到 2007年12月新診斷為乳癌之病歷資料，追蹤至2008年12月，納入第Ⅰ期-第Ⅲ期的乳癌病患，有效樣本數共418位，病患的相關資料來自於病理切片報告、臨床紀錄。統計方法使用Kaplan-Meier來估計存活率與無復發率，並進一步採用log-rank檢定各存活曲線間是否有達顯著差異。同時透過Cox proportional hazards model或time- dependent covariates的Cox regression model探討影響乳癌病患復發與死亡之預後因子。結果：病患平均年齡中位數為50歲，5年無復發率及整體存活率，分別為79%與87%。單變量分析：腫瘤分期、腫瘤大小、腋下淋巴結轉移顆數、組織分化程度、細胞核分化程度、血管或淋巴管的侵犯、合併治療方式與復發率有達到顯著性差異；腫瘤期別、腫瘤大小、腋下淋巴結轉移個數、組織分化程度、細胞核分化程度、血管或淋巴管的侵犯、PR狀態、合併治療方式與死亡率有達到顯著性差異。多變量分析：控制其他變項下，每增加一顆淋巴結轉移個數，復發機率就增加7%；控制其他變項下，第Ⅲ期是第Ⅰ或Ⅱ期死亡機率的22.97倍，此外，在控制其他變項之下，每增加1顆淋巴結轉移顆數，死亡機率就增加7%。PR狀態方面，在控制其他變項之下，陰性是陽性死亡機率的8.97倍，另外，組織分化程度方面，在控制其他變項下，Grade Ⅲ是GradeⅠorⅡ死亡機率的3.18倍。合併治療方面，在控制其他變項下，手術加上化學治療、放射線治療與荷爾蒙治療且腫瘤分期為第Ⅲ期是手術加上化學治療且腫瘤為第ⅠorⅡ期死亡機率的1.41倍。結論：腋下淋巴結轉移顆數視為可強烈預測復發機率，此外，腋下淋巴結轉移顆數、組織分化程度、PR狀態、腫瘤分期、合併治療方式與腫瘤分期交互作用項，這些共變量(預後因子)是可顯著預測死亡機率。

關鍵字

乳癌；存活分析； Cox比例危害模式；預後因子

並列摘要

Objective:This study aimed to assess prognostic factors on mortality and recurrent rate of patients diagnosed as breast cancer. Methods and Materials:From January 2000 to December 2007,the study performed a retrospective review of 418 patients with stageⅠ-Ⅲ invasive breast cancers, and followed-up to December 2008.Patients,disease and treatment data were extracted from medical records and pathological records.The Kaplan-Meier mothod and log-rank test were used to estimate and compare the survival and non-recurrent rate.The effects of potential prognostic factors were assessed using Cox proportional hazards model or time-dependent covariates Cox regression model. Results: 418 patients with a median age of 50. 5-year non-recurrent rate was 79% ,and 5-year survivial rate was 87%.Using univariate analysis we found,prognostic factors related to recurrent rate were stage,tumor size, positive axillary lymph node,histological grade,nuclear grade, vascular invasion,and treatment modality; prognostic factors related to survival rate were stage,tumor size,positive axillary lymph nodes, histological grade,nuclear grade, vascular invasion,PR status and treatment modality. The multivariate analysis after controlling the other covariates factors, positive axillary lymph nodes were found significantly impact on recurrent rate.After controlling the other factors, positive axillary lymph nodes,stage, histological grade,PR status, and treatment modality*stage were found significantly impact on mortality. Conclusion: Positive axillary lymph nodes is an independent predictor of recurrent rate after consideration of other strong prognostic factors, except that positive axillary lymph nodes,stage,histological grade, PR status, and treatment modality*stage were independently prognostic factors of mortality.