乳腺癌神经浸润与临床病理特征的关系及预后分析

彭浦超; 陈莉杰; 宣浩军; 姚敏; 邓再兴; 张昕; 丁秀芳

doi:10.16766/j.cnki.issn.1674-4152.003834

乳腺癌神经浸润与临床病理特征的关系及预后分析

doi: 10.16766/j.cnki.issn.1674-4152.003834

彭浦超^{1, 2},
陈莉杰^2, ,,
宣浩军³,
姚敏²,
邓再兴⁴,
张昕⁴,
丁秀芳²

1.
浙江中医药大学研究生院，浙江杭州 310053
2.
湖州市妇幼保健院乳腺科，浙江湖州 313000
3.
浙江省肿瘤医院乳腺外科，浙江杭州 310000
4.
湖州市妇幼保健院病理科

基金项目:

浙江省医药卫生科技计划项目 2023KY588

详细信息

通讯作者:
陈莉杰，E-mail: clj961001@163.com

中图分类号: R737.9 R730.7
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- 文章访问数: 38
- HTML全文浏览量: 18
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-01-28
- 网络出版日期: 2025-02-13

Relationship of perineural invasion with clinicopathological features and prognosis in breast cancer patients

1.
Graduate School, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China

摘要

摘要: 目的神经浸润在乳腺癌中的预后和生存意义尚未明确，本研究旨在分析其与乳腺癌临床病理特征的关系及对预后的影响，为精准评估乳腺癌的预后提供依据。方法选取2018年1月—2021年12月在湖州市妇幼保健院诊治的159例乳腺癌患者为研究对象，根据患者是否存在神经浸润，分为神经浸润组(43例)和非浸润组(116例)。比较2组临床病理特征，采用单因素及多因素logistic回归分析影响乳腺癌发生神经浸润的危险因素，用Kaplan-Meier法绘制生存曲线，比较2组无病生存期的差异。采用Cox回归分析探究影响乳腺癌患者预后的因素。结果 159例乳腺癌中，43例(27.0%)发生神经浸润。单因素分析显示，2组T分期、腋窝淋巴结转移、TNM分期、Ki-67表达水平差异均有统计学意义(P < 0.05)；多因素logistic二元回归分析显示，腋窝淋巴结转移、TNM分期、Ki-67表达水平均为乳腺癌发生神经浸润的独立影响因素(P < 0.05)。43例伴神经浸润患者无病生存率为67.4%，116例无神经浸润患者无病生存率为87.9%，差异有统计学意义(χ²=12.693，P < 0.05)。单因素Cox回归分析显示，雌激素受体、孕激素受体、T分期、TNM分期、核分级、神经浸润、分子分型均为患者预后的影响因素(P < 0.05)；多因素Cox回归分析显示，三阴型乳腺癌、神经浸润均为患者的独立预后因素(P < 0.05)。结论腋窝淋巴结转移、TNM分期、Ki-67高表达是乳腺癌发生神经浸润的独立相关因素，神经浸润是乳腺癌患者的独立预后因素，可作为评价预后的指标。
- 乳腺癌 /
- 神经浸润 /
- 预后
Abstract: Objective The prognostic and survival significance of perineural invasion in breast cancer was not clear, the relationship of perineural invasion with clinicopathological characteristics and the effect on the prognosis of breast cancer were analyzed, so as to provide a basis for accurate evaluation of the prognosis of breast cancer. Methods A total of 159 breast cancer patients in Huzhou Maternal and Child Health Care Hospital from January 2018 to December 2021 were selected as the study subjects. According to the presence of perineural invasion, the patients were divided into the PNI-positive group (n=43) and the PNI-negative group (n=116). The clinicopathological characteristics of two groups of breast cancer patients were compared, and univariate and multivariate logistic regression analysis were used to analyze the risk factors of neural invasion of breast cancer. Moreover, the Kaplan-Meier method was used to draw survival curves to compare the differences in disease-free survival between the two groups of patients. Meantime, Cox regression analysis was used to explore the factors affecting the prognosis of breast cancer patients. Results Among 159 cases of breast cancer, 43 cases (27.0%) had a perineural invasion. Univariate analysis showed that T stage, axillary lymph node metastasis, TNM staging, and the expression levels of Ki-67 of breast cancer were correlated with perineural invasion (P < 0.05); In the logistic binary regression analysis with multiple factor analysis, axillary lymph node metastasis, TNM staging, and the expression levels of Ki-67 were independent factors influencing the occurrence of breast cancer perineural invasion(P < 0.05). The disease-free survival rate of 43 patients with nerve infiltration was 67.4%, while the disease-free survival rate of 116 patients without nerve infiltration was 87.9%. The difference in disease-free survival rates between the two groups was statistically significant (χ²=12.693, P < 0.05). The results of univariate Cox regression analysis showed that estrogen receptor, progesterone receptor, T stage, TNM staging, nuclear grade, neural infiltration, and molecular typing were the prognostic factors for breast cancer patients (P < 0.05); Cox regression analysis showed that triple-negative breast cancer and perineural invasion were independent prognostic factors of patients with breast cancer (P < 0.05). Conclusion Axillary lymph node metastasis, TNM staging, and Ki-67 overexpression were independent related factors of nerve invasion in breast cancer, perineural invasion was an independent prognostic factor of breast cancer patients. It could be used as an indicator to evaluate the prognosis of patients.
- Breast carcinoma /
- Perineural invasion /
- Prognosis

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图 1 神经浸润阳性、阴性乳腺癌患者生存曲线

Figure 1. Survival curve of breast cancer with positive and negative nerve infiltration

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表 1 2组乳腺癌患者临床病理因素比较(例)

Table 1. Comparison of clinicopathological factors between two groups of breast cancer patients (cases)

项目	神经浸润 (n=43)	无神经浸润 (n=116)	统计量	P值
年龄			0.444^a	0.506
≤50岁	16	50
＞50岁	27	66
T分期			-3.922^b	＜0.001
T1	13	70
T2	24	46
≥T3	6	0
淋巴结转移			41.761^a	＜0.001
无	3	75
有	40	41
核分级			-1.424^b	0.155
Ⅰ	4	18
Ⅱ	17	52
Ⅲ	22	46
ER			0.009^a	0.923
阴性	13	36
阳性	30	80
PR			0.299^a	0.585
阴性	15	46
阳性	28	70
Her-2			0.521^a	0.417
阴性	29	85
阳性	14	31
TNM分期			-7.116^b	＜0.001
Ⅰ	1	53
Ⅱ	17	55
Ⅲ	25	8
分子分型			1.800^a	0.182
Luminal A型	3	28
Luminal B型	18	36
Her-2阳性型	14	31
三阴型	8	21
Ki-67			9.746^a	0.002
< 15%	2	31
≥15%	41	85
放疗			3.145^a	0.076
是	29	60
否	14	56
手术方式			1.339^a	0.247
保乳±腋窝清扫	9	35
全乳切除±腋窝清扫	34	81
化疗			2.439^a	0.118
是	42	102
否	1	14
注: ^a为χ²值，^b为Z值。

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表 2 乳腺癌患者发生神经浸润相关因素的多因素分析

Table 2. Multivariate analysis of factors related to nerve invasion in breast cancer patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
Ki-67(高表达vs.低表达)	1.722	0.878	3.845	0.049	5.596	1.001~31.297
腋窝淋巴结转移(有vs.无)	2.610	1.085	5.782	0.016	13.599	1.620~114.145
TNM分期			12.426	0.002
Ⅰ期vs.Ⅲ期	-2.154	1.624	1.564	0.185	0.116	0.005~1.796
Ⅱ期vs.Ⅲ期	-1.861	0.529	12.393	＜0.001	0.155	0.055~0.438
T分期(≥T2 vs.T1)	0.233	0.538	0.187	0.665	1.262	0.440~3.626

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表 3 乳腺癌根治术后患者预后影响因素的单因素分析

Table 3. Univariate analysis of prognostic factors in breast cancer patients following radical mastectomy

变量	B	SE	Waldχ²	P值	HR值	95% CI
年龄	-0.245	0.379	0.417	0.518	0.783	0.372~1.645
ER	-1.174	0.380	9.517	0.002	0.309	0.147~0.652
PR	-1.318	0.397	11.037	0.001	0.268	0.123~0.583
Her-2	-0.422	0.461	0.837	0.360	0.656	0.265~1.619
Ki-67	3.444	1.887	3.332	0.068	31.315	0.776~1 264.032
腋窝淋巴结转移	0.548	0.411	1.781	0.182	1.730	0.773~3.867
T分期	0.717	0.317	5.114	0.024	2.048	1.100~3.813
TNM分期	0.682	0.268	6.476	0.011	1.978	1.170~3.345
核分级	0.734	0.323	5.169	0.023	2.084	1.107~3.926
神经浸润	1.304	0.395	10.930	0.001	3.686	1.701~7.987
分子分型	0.911	0.221	16.908	＜0.001	2.486	1.611~3.837
放疗	-0.248	0.395	0.394	0.530	0.781	0.360~1.692
手术方式	-0.683	0.494	1.911	0.167	0.505	0.192~1.330
化疗	1.196	1.019	1.378	0.241	3.307	0.449~24.376

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表 4 乳腺癌根治术后患者预后影响因素的多因素分析

Table 4. Multivariate analysis of prognostic factors in patients with breast cancer following radical mastectomy

变量	B	SE	Waldχ²	P值	HR值	95% CI
神经浸润	1.489	0.536	7.705	0.006	4.432	1.549~12.681
分子分型			10.646	0.014
Luminal A型vs.三阴型	-3.161	1.425	4.922	0.027	0.042	0.003~0.692
Luminal B型vs.三阴型	-2.484	1.036	5.749	0.016	0.083	0.011~0.635
Her-2阳性型vs.三阴型	-2.603	0.818	10.116	0.001	0.074	0.015~0.368
ER	0.989	1.027	0.926	0.336	2.687	0.359~20.126
PR	-0.885	0.745	1.411	0.235	0.413	0.096~1.778
核分级			0.094	0.954
Ⅱvs.Ⅰ	0.268	1.128	0.056	0.812	1.307	0.143~11.914
Ⅲvs.Ⅰ	0.335	1.138	0.087	0.768	1.399	0.150~13.021
T分期			0.348	0.840
T2 vs.T1	0.094	0.517	0.033	0.856	1.099	0.399~3.023
≥T3 vs.T1	-0.411	0.933	0.194	0.660	0.663	0.106~4.132
TNM分期			1.975
Ⅱ vs.Ⅰ	1.077	0.770	1.957	0.162	2.935	0.649~13.262
Ⅲ vs.Ⅰ	0.976	0.939	1.082	0.298	2.654	0.422~16.704

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