乳腺癌骨转移发生骨相关事件的危险因素及其对患者生存期的影响

The risk factors of skeletal-related events and their influence on survival in breast cancer patients with bone metastases

目的 探讨乳腺癌骨转移发生骨相关事件( SREs)的危险因素及SREs对骨转移患者生存期的影响.方法 纳入2010年1月—2017年6月上海交通大学医学院附属瑞金医院收治的乳腺癌骨转移患者共123例进行回顾性研究,123例患者均为女性,按末次随访时是否发生SREs分为不伴SREs组与伴SREs组,对比两组患者的年龄、乳腺癌病理类型与分级、生物学标记表达特征、腋窝淋巴结侵犯与否、骨转移时间、骨转移灶数量等临床因素.分别采用χ2 检验和logistic回归分析进行单因素、多因素分析SREs发生的危险因素.两组患者的预后生存差异采用Kaplan-Meier法进行分析.结果 123例乳腺癌骨转移患者,年龄23~78(53.9 ± 11.3)岁,不伴SREs组与伴SREs组分别为61例、62例.单因素分析按P≤0.1纳入多因素分析,结果显示,两组患者腋窝淋巴结是否受累、骨转移时间、骨转移灶数目的及骨外转移差异均有统计学意义(P值均<0.1),而其余相关临床特征差异均无统计学意义(P值均>0.1).多因素分析显示,两组患者腋淋巴结转移侵犯、多发骨转移灶的差异均有统计学意义(P值均<0.05).伴SREs组患者共发生SREs 95例次,发生频率由高到低依次为:骨放疗34例次(35.8% )、病理性骨折32例次(33.7% )、脊髓压迫13例次(13.7% )、骨科手术9例次(9.5% )、高钙血症7例次(7.4% ).生存分析结果显示,不伴SREs组与伴SREs组患者中位骨转移生存时间分别为54个月与35个月,组间比较差异有统计学意义( P<0.05).结论 对乳腺癌骨转移患者而言,肿瘤腋窝淋巴结侵犯与多发骨转移灶是发生SREs的危险因素,而伴发SREs预示着预后不佳.

Objective To explore the risk factors of skeletal-related events(SREs)and their influence on the survival of breast cancer patients with bone metastases.Methods Relevant clinical data and outcomes of 123 female breast cancer patients with bone metastases in Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital between January 2010 and June 2017 were retrospectively reviewed.All patients were divided into SREs group or non-SREs group according to whether SREs occurred at the last follow-up.The clinical features,including age,pathology,molecular characteristics of breast cancer,axillary lymph node metastasis,bone metastasis interval,and number of bone metastasis,were analyzed and compared between two groups.Univariate and multivariate analysis were performed using chi-square test and logistic regression analysis to explore the risk factors for SREs.The prognosis survival difference between the two groups was analyzed by Kaplan-Meier test.Results One hundred and twenty-three consecutive patients with the average age of(53.9±11.3)years(range,23-78 years)were identified during study period.The number of patients with SREs or non-SREs was 61 cases and 62 cases.There were significant differences in the number of axillary lymph nodes bone metastasis interval,outside the bone metastasis and the number of bone metastases(all P values<0.1),between the two groups,but the age,tumor grade,hormone receptor status,histological type,visceral metastases were not statistically significant(all P values>0.05).Multivariate analysis showed that the difference of lymph node metastasis and multiple bone metastasis between the two groups was statistically significant(all P values<0.05).Totally,the group of SREs occurred SREs.The frequency of SREs occurrence from high to low in SREs group was radiation therapy for bone metastases(n=34,35.8%),pathological fracture(n=32,33.7%),spinal cord compression(n=13,13.7%),surgery for bone lesion(n=9,9.5%),hypercalcemia(n=7,7.4%).Survival analysis showed the median survival time of non-SREs group and SREs group were 54 months and 35 months respectively,and the difference was statistically significant(P<0.05).Conclusions Axillary lymph node metastases and multiple bone metastases are independent risk factors for SREs,and SREs indicate poor prognosis in breast cancer patients with bone metastases.