首诊Ⅳ期乳腺癌骨转移患者的临床病理特征及预后分析

孙建娜; 刘红; 孔令军; 远小东

doi:10.3969/j.issn.1000-8179.2019.18.595

首诊Ⅳ期乳腺癌骨转移患者的临床病理特征及预后分析

doi: 10.3969/j.issn.1000-8179.2019.18.595

孙建娜^{①, ②,},
刘红^②, ,,
孔令军^①,
远小东^③

①.
河北省沧州中西医结合医院乳腺外科
②.
天津医科大学肿瘤医院乳腺肿瘤二科
③.
任丘市友谊医院外科

详细信息

作者简介:
孙建娜专业方向为乳腺肿瘤临床治疗及肿瘤信号转导通路机制等基础研究。E-mail:SJN15833179939@163.com

通讯作者:
刘红 lh713@163.com

计量
- 文章访问数: 135
- HTML全文浏览量: 73
- PDF下载量: 9
- 被引次数: 0
出版历程
- 收稿日期: 2019-05-27
- 刊出日期: 2019-09-30

Clinicopathological features and prognostic analysis of initially diagnosed stage Ⅳ breast cancer bone metastasis

Sun Jianna^{①, ②
,},
Liu Hong^{②
, ,},
Kong Lingjun^①,
Yuan Xiaodong^③

①.
Department of Breast Surgery, Cangzhou Hospital of Integrated TCM-WM, Cangzhou 061000, China
②.
The Second Department Breast Cancer Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
③.
Department of Surgery, Renqiu People's Hospital, Renqiu 062550, China

More Information

Corresponding author: Hong Liu; E-mail:lh713@163.com

摘要

摘要: 目的探讨首诊Ⅳ期乳腺癌骨转移（initially diagnosed stage Ⅳ breast cancer bone metastasis，IDBCBM）患者的临床病理特征、治疗和预后的关系。方法回顾性分析2007年3月至2016年11月天津医科大学肿瘤医院收治的74例IDBCBM患者的临床资料，并行单因素分析和采用Cox回归模型进行多因素分析。结果患者的中位年龄为53.3岁。中位总生存时间（overall survival，OS）为34.3个月，3年和5年的生存率分别为37.8%和12.2%。首发转移模式仅为骨转移的患者预后较好，中位生存时间为41.7个月，3年和5年的总生存率分别为54.5%和20.4%。在单因素分析中，分子亚型、激素受体状态、HER-2表达情况、淋巴结状态、Ki-67指数、骨转移数目（number of bone metastasis，NBM）、初始转移模式、药物治疗模式及局部治疗与预后相关；74例IDBCBM患者的Cox回归模型多因素分析显示首发骨转移模式，NBM，药物治疗模式，Ki-67均是影响患者OS的独立预后因素（均P < 0.05）。结论 Ki-67的高表达、单一的药物治疗模式、NBM较多、骨合并内脏转移均与患者预后较差相关，但局部的手术和放疗是否获益尚无定论。
- 首诊Ⅳ期乳腺癌骨转移 /
- 临床病理特征 /
- 治疗 /
- 预后
Abstract: Objective To examine the relationship of clinicopathological features and treatment strategies with the prognosis of patients with initially diagnosed stage Ⅳ breast cancer bone metastasis (IDBCBM). Methods Clinical data from 74 patients with IDBCBM who were treated at Tianjin Medical University Cancer Institute and Hospital between March 2007 and November 2016 were analyzed retrospectively. A univariate analysis of prognosis was conducted using a Log-rank test, and the subsequent multivariate analysis was conducted using a Cox regression model. Results The median age of the patients was 53.3 years. The median total survival duration (overall survival, OS) was 34.3 months, and the 3- and 5-year survival rates were 37.8% and 12.2%, respectively. Patients for whom the first distant metastasis was bone metastasis only had a better prognosis, with a median survival duration of 41.7 months and overall 3- and 5-year survival rates of 54.5% and 20.4%, respectively. In the univariate analysis, molecular subtype, hormonal receptor status, HER-2 expression levels, nodal status, Ki- 67 index, number of bone metastases (NBM), initial mode of metastasis, mode of therapy, and locoregional treatment showed an association with prognosis. Further, multivariate analysis demonstrated that Ki-67 index, NBM, mode of therapy, and initial mode of metastasis were independent factors affecting OS (P < 0.05). Conclusions A high Ki-67 index, single mode therapy, the presence of multiple bone metastases, and accompanying visceral metastasis were associated with a poor prognosis. However, it remains unclear whether locoregional treatment, including surgery and radiotherapy treatment of the primary tumor, is beneficial.
- initially diagnosed stage Ⅳ breast cancer bone metastasis (IDBCBM) /
- clinicopathological characteristics /
- treatment /
- prognosis

HTML全文

表 1 单纯骨转移组和骨转移合并内脏转移组临床病理特征和治疗情况

表 2 74例IDBCBM患者的单因素分析

表 3 74例IDBCBM患者预后的Cox回归模型多因素分析

参考文献(12)

[1]	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2):115-132. doi: 10.3322/caac.21338
[2]	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015[J]. CA Cancer J Clin, 2015, 65(1):5-29. doi: 10.3322/caac.21254
[3]	Rucci N, Sanita P, Delle Mhonache S, et al. Molecular pathogenesis of bone metastases in breast cancer:proven and emerging therapeutic targets[J]. World J Clin Oncol, 2014, 5(3):335-347. doi: 10.5306/wjco.v5.i3.335
[4]	Wang X, Yang KH, Wanyan P, et al. Comparison of the efficacy and safety of denosumab versus bisphosphonates in breast cancer and bone metastases treatment:a meta-analysis of randomized controlled trials[J]. Oncol Lett, 2014, 7(6):1997-2002. doi: 10.3892/ol.2014.1982
[5]	Hölzel D, Eckel R, Bauerfeind L, et al. Survival of de novo stage Ⅳ breast cancer patients over three decades[J]. J Cancer Res Clin Oncol, 2017, 143(3):509-519. doi: 10.1007/s00432-016-2306-1
[6]	Miao H, Hartman M, Bhoo-Pathy N, et al. Predicting survival of de novo metastatic breast cancer in Asian women:systematic review and validation study[J]. PLoS One, 2014, 9(4):e93755. doi: 10.1371/journal.pone.0093755
[7]	Leone BA, Vallejo CT, Romero AO, et al. Prognostic impact of metastatic pattern in stage Ⅳ breast cancer at initial diagnosis[J]. Breast Cancer Res Treat, 2017, 161(3):537-548. doi: 10.1007/s10549-016-4066-7
[8]	Wu SG, Li H, Tang LY, et al. The effect of distant metastases sites on survival in de novo stage-Ⅳ breast cancer:A SEER database analysis[J]. Tumour Biol, 2017, 39(6):1010428317705082. http://cn.bing.com/academic/profile?id=53b13e57f0c7cb6aae3a5eb0a4add184&encoded=0&v=paper_preview&mkt=zh-cn
[9]	Soni A, Ren Z, Hameed O, et al. Breast cancer subtypes predispose the site of distant metastases[J]. Am J Clin Pathol, 2015, 143(4):471-478. doi: 10.1309/AJCPYO5FSV3UPEXS
[10]	Smid M, Wang Y, Zhang Y, et al. Subtypes of breast cancer show preferential site of relapse[J]. Cancer Res, 2008, 68(9):3108-3114. doi: 10.1158/0008-5472.CAN-07-5644
[11]	Gong Y, Liu YR, Ji P, et al. Impact of molecular subtypes on metastatic breast cancer patients:a SEER population-based study[J]. Sci Rep, 2017, 7:45411. doi: 10.1038/srep45411
[12]	von Moos R, Body JJ, Rider A, et al. Bone-targeted agent treatment patterns and the impact of bone metastases on patients with advanced breast cancer in real-world practice in six European countries[J]. J Bone Oncol, 2017, 11:1-9. http://cn.bing.com/academic/profile?id=5b3c7102b751e00c433a23853322ecbb&encoded=0&v=paper_preview&mkt=zh-cn