无法手术切除的乳腺癌单纯性肝转移患者治疗的回顾性分析

The Retrospective Analysis of the Treatment for Alone Hepatic Metastatic Breast Carcinoma not suitable for Excision After the Primary Lesion Removal

目的:探讨乳腺癌术后单纯性肝转移无法切除时的治疗方法,分析影响患者预后的因素。方法:对52例无法切除乳腺癌术后单纯性肝转移患者的临床资料进行回顾性分析,采用生存分析并结合文献讨论影响患者预后的因素。结果:52例患者发现肝转移后,最短和最长生存时间分别为7和38个月,平均生存时间为22.6月,中位生存时间为22月。生存分析显示采用肝动脉介入化疗栓塞结合全身静脉化疗可提高临床受益率(P<0.001),对于HER2阳性患者,采用曲妥珠单抗可提高临床受益率(P=0.029);而初次手术至发现肝脏转移之间时间间隔越短,患者生存期越短(P<0.001);积极化疗可延长生存期(P<0.001),采用蒽环类化疗较紫杉醇更能延长患者生存期(P=0.014),而给药途径对患者的生存期影响无统计学意义(P>0.05)。结论:对于乳腺癌术后出现肝转移的患者,若无法手术切除,采用积极的化疗可延长患者的生存期,而肝动脉介入化疗栓塞结合全身静脉化疗可提高患者的临床受益率。

Objective To explore the effective treatment for alone hepatic metastatic breast carcinoma not suitable for excision after the primary lesion removal,and analyze the prognostic factors.Methods The clinical data of 52 cases of alone hepatic metastatic breast carcinoma after the primary lesion removal were analyzed retrospectively,and the prognostic factors were explored according to survival analysis,and pervious reports.Results The minimum and maximum survival time were 7 and 38 months,and the average and median survival time were 22.6 and 22.0 months,respectively.The efficacy could be improved by transcatheter hepatic arterial chemoembolization combined the systemic venous chemotherapy than the systemic venous chemotherapy alone(P<0.001),and Herceptin-targeted therapy could improve the efficacy for the HER2 positive patients(P=0.029).The shorter interval time between primary operation and hepatic metastatic lesion,the worse prognosis would be(P<0.001),and the aggressive chemotherapy could improve the prognosis(P<0.001),and anthracyclines could prolong the survival time than docetaxel chemotherapeutics(P=0.014),but the route of administration didn't affect the survival time(P>0.05).Conclusion The aggressive chemotherapy can improve the prognosis for unsuitable excision hepatic metastatic breast carcinoma after primary lesion removal,and the transcatheter hepatic arterial chemoembolization combined the systemic venous chemotherapy can more efficiently improve the clinical efficacy than the systemic venous chemotherapy alone.