乳腺癌患者术后不同部位复发转移的风险分布

Time distribution of breast cancer recurrence in different sites after surgical operation

背景与目的:乳腺癌患者术后有其常见的转移部位,有研究认为乳腺癌的转移是呈一定的时间规律分布,然而各不同部位的转移规律及相互关系则鲜有报道。本研究旨在探讨复发的风险规律以及其在不同部位间差异。方法:回顾性分析2005年1月—2007年5月在我院乳腺科专家门诊连续接诊的手术后复发或转移的210例患者,分析局部复发、远处转移,以及淋巴结、骨、肝、肺等不同转移部位的年复发风险时间分布。复发风险采用Cox风险函数估计,并运用Kernel平滑曲线作图。结果:根据乳腺癌预后因子进行分层分析发现乳腺癌患者术后的年事件风险曲线呈双峰模式,术后第2.5年和第9年高危复发者双峰风险高度显著高于中低危患者。局部复发与远处转移的年事件风险亦呈现双峰型模式,局部复发的风险曲线双峰出现均分别早于远处转移2～3年。淋巴结、骨、肺、肝等部位转移的双峰出现的事件基本一致,但均晚于局部复发时间。结论:乳腺癌患者术后不同部位转移均存在一定的时间分布规律,局部复发和内脏转移的主要机制可能有所不同,前者可能是后者的先兆,应特别注意中高危患者的局部复发征象。

Background and purpose： The patients with breast cancer tend to have some frequent metastasis sites after mastectomy, and previous studies showed that there were some regular patterns for time distribution of metastasis. However, the patterns and the relationships between different metastasis sites were rarely reported. We aimed to analysis the rules of hazard rates of recurrence and differences of rules among different metastatic sites. Methods： We performed a retrospective study of 210 female breast cancer patients who were continuously followed up in our hospital from January 2005 to May 2007 and had complete data of metastasis. The time distributions of recurrence in different sites were estimated by Cox hazard function. Results： The annual risk hazard curve for breast cancer patients showed a double-peaked pattern. When stratified by the prognostic factors, the annual risk hazard curve of the patients with high risk of recurrence had double peaks at two to three years and nine years after mastectomy respectively, and it was significantly higher than those of the patients with middle and low risk of recurrence. Annual risk hazard curves of both local relapse and metastasis also showed a double-peaked pattern, while the curve of local relapse emerged 2 to 3 years earlier. The curves for lymph node, bone, lung and liver metastasis showed a similar pattern, but all the peaks of curve emerged later than that of the local relapse. Conclusions： There were certain regular patterns of time distribution for different metastasis sites after mastectomy. The major mechanism of local recurrence and metastasis may he different, and the former may he the foreboding for the latter. We should pay attention to the local relapse signs especially in the patients with high risk.