ki67表达程度对乳腺癌术后放疗价值的影响-influence of ki67 expression level on postoperative radiotherapy value of breast cancer.docxVIP

目录中文摘要··············································································1英文摘要··············································································5英文缩写·············································································10研究论文Ki-67表达程度对乳腺癌术后放疗价值的影响前言·············································································11材料与方法····································································12结果·············································································14附图·············································································18附表·············································································24讨论·············································································30结论·············································································33参考文献·······································································34综述Ki-67表达程度对乳腺癌术后放疗价值的影响···················37致谢···················································································45个人简历·············································································46Ki-67表达程度对乳腺癌术后放疗价值的影响摘要目的：分析Ki-67表达程度对乳腺癌术后放疗价值的影响。方法：回顾性分析2009年1月至2009年12月之间于河北医科大学第四医院首次行乳腺癌手术的779例患者病例资料，排除条件包括：男性乳癌，双乳癌，原位癌，Paget’s病，首诊手术时TNM分期为IV期的患者，排除13例。根据术后免疫组化结果，将患者分为Ki-67低表达组（Ki-6715%）及Ki-67高表达组(Ki-67≥15%)，随访所有病人，起始日期为手术日期至死亡、最后失访日期或2015年7月1日。以术后放疗与否及乳腺癌肿瘤组织免疫组化Ki-67表达程度为主变量，以年龄、月经状态，肿瘤大小、分级、类型，脉管瘤栓状态，阳性淋巴结数目、内分泌治疗、化疗情况为协变量。在描述人群及疾病相关特征时，连续性变量计算平均值（标准差）和中位数，组间比较采用t检验，分类变量计算百分数，组间比较采用χ2检验。使用Kaplan–Meier(KM)法及Log-Rank检验估计和绘制生存曲线，分析总体生存（OS）和无病生存（DFS）。采用单、多因素Cox比例风险回归模型分析独立变量单独和联合时对OS及DFS的相关性，并计算风险比(hazardratio,HR)、95%可信区间（95%CI）及相应P值，以P0.05为有统计学意义。统计软件为SPSS22.0。结果：1人群整体资料本研究总体人群共779例，Ki-67低表达组（Ki-6715%）占41.3%，及Ki-67高表达组(Ki-67≥15%)占54.4%。总体人群中，平均年龄50.5岁（20-82），绝经前为50.3%（392例），行腋窝清扫术96.9%（755），行保乳术5%（44），导管癌74.3%（579），小叶癌10.8%（84），术后放疗33.4%（260），内分泌治疗者占60.4%（470），术后化疗98.6%（706）。总体死亡率为13.0%（92）、治疗失败（复发+转移+死亡）率为19.7%（141）。人群中位随访时间为73.3个月。随访率93.8%。2放疗组与