| Objective: At present, breast cancer is one of the most commonmalignant tumors in women, which has high heterogeneity, and differentgenotyped has different biological characteristics. Among them, Luminal A isone of the four major subtypes of breast cancer, and its' prognosis is relativelygood, but its' diagnosis and treatment has no unified standards. This topicmainly studies the treatment of Luminal type A breast cancer and its'prognosis,under the guidance of cNCCN breast cancer guidelines, andfurther more to explore the biology characteristics of this subtype of breastcancer, so as to provide more standardized treatment information for theclinician.Methods:1Collect704cases of breast cancer patients,who had surgery andconfirmed by histopathological,from January2006to December2010in thefourth hospital of Hebei Medical University, and should following theconditions: ER or PR is positive, Cerb-B2(-) or (+), have complete materialand do postoperative adjuvant therapy (Note: in this experiment, the patients'Cerb-B2(+),but did not do CISH or FISH detection we known it as HER-2negative). At the same time, the patients' relevant information were collected,including age, menopause status, tumor size, pathological types, histologicalgrade, vessel tumor embolus, the total number of lymph nodes, the state oflymph nodes, and the clinical stages and so on, then the Excel database wereestablished. All the patients who in the group were follow-up visited,startingat its surgery date, the end time is the death day or the last follow-up time.2The deadline for follow-up is December2011,01. During the follow-uptime, the patients who dying of other reasons,and the patients who stillsurvive at the deadline are calculated for cut-off values. 3The treatment and prognosis of Luminal type A breast cancer wasretrospectively analysed. The patients were divided into standard group andnon-standard group,according to every year' cNCCN guidelines standards,the differences of recurrence rate, disease free survival and overall survivalbetween the two groups were compared.4The data was organized and processed with SPSS13.0statisticalsoftware. The clinical data was described by percentage.The comparation ofclinical and pathological features were analyzed by χ2test; The survivalcondition of Patients was analyzed by Kaplan-Meier method; Survival ratewas compared by Log-rank test. The analysis of single factor, multiplefactorwas used Cox regression analysis; Significant inspectionstandard: P <0.05.Result:1The patients coincidence rate was22.87%(161/704), in which thepatientd treated with regulating comprehensive therapy according to thecNCCN guidelines (including chemotherapy, radiotherapy,endocrinetherapy).Standard chemotherapy coincidence rate was29.40%(207/704),standard radiotherapy coincidence rate was83.24%(586/704),standardendocrine therapy accord rate was76.99%(542/704).2006-2010;Thestandardized treatment coincidence rates were7.89%,12.5%,18.40%,22.4%,31.78%respectively.2The total recurrence and metastasis rate of704patients was16.76%(including69patients deaths,49patients had recurrence and metastasis stillalive). In the standard group there were8cases had recurrence and metastasis(4.97%), the non-standard group were110cases (20.26%). The recurrence andmetastasis rate in standard group was significantly lower than non-standardgroup, and have a statistics difference (P=0.00).The local recurrence rate of704patients was4.64%, the rate of distantmetastases accounted for13.62%, in which the standard group accounted for0.62%and1.24%; non-standard group accounted for5.34%and15.54%. Theincidence rate of local recurrence, and distant metastasis rate in standardgroup was significantly lower than non-standard group, it had statistics difference (P=0.009.P=0.000).It's rarely metastasize to internal organs, andit's very common to bone.3The2,3,5year survival rates in standards group were99.1%,99.1%,88.1%, and non-standard group were95.5%,91.5%,60.9%; The two groupshad statistical differences (P=0.015). The2,3,5years of disease-freesurvival rates in standard group were98.3%,94.8%,75.4%, and non-standardgroup were92.2%,87.7%,39.7%, there had significant differences betweenthe groups(P=0.001).4There were646cases of patients had follow-up results.The relationshipbetween the clinical pathological-index and the prognosis was analyzed byCOX regression analysis, the P <0.05in the single factor was brought intoCOX regression model into multiple factor analysis, the results showedthat:menopausal status, the clinical stages, the total number of lymph nodeswere the independent factors which influence the overall survival in theLuminal typeA breast cancer;clinical stage, the state of menopause were theindependent factors,which influence the disease-free survival in Luminaltype A breast cancer.Conclusions:1The research shows that:there are161patients receivedstandardizedcomprehensive treatment, according to guidelines standards(22.87%) and543patients have not received standardized comprehensive treatment(77.13%).2The proportion of patients who received standardized comprehensivetreatment, according cNCCN guideline increasing year by year. Thenormalization degree of breast cancer treatment in our country continuousimprove.Comply with cNCCN guide Luminal type A breast cancer patientscan benefit.3The relapse and metastasis rate, local transfer rate and distantmetastasis rate of the patients,who received treatment according to cNCCNguide lower than the patients who fails to guide the cNCCN.4It's rarely metastasize to internal organs, and it's very common to bone.5The disease-free survival rates and overall survival of the patients whoreceived treatment according to cNCCN guide, higher than the patients whofails to guide the cNCCN.6COX model multiple factor analysis shows that menopausal status,clinical stage, the total number of lymph nodes are the independent factors,which influence the overall survival in Luminal type A breast cancer;clinicalstage, menopausal status are the independent factors which influence thedisease-free survival state. |
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