乳腺癌骨转移的危险因素及放疗疗效分析

Analysis of Risk Factors and Radiotherapy of Bone Metastases in Breast Cancer

目的：研究乳腺癌骨转移的主要危险因素和放射治疗效果。方法：使用多重逐步Cox回归分析85例乳腺癌患者骨转移的主要危险因素,并回顾分析了30例乳腺癌骨转移患者接受放射治疗的效果。结果：20例治疗患者中疼痛完全缓解率75%,总有效率（完全缓解＋部分缓解）占85%。治疗后的1、2、3 a生存率分别为65%、25%、5%,中位生存期15个月。而10例未接受放射治疗患者的中位生存期6个月（P〈0.01）。通过多因素Cox逐步回归分析,发现骨转移的主要危险因素有3项：（1）临床分期,Ⅳ期-Ⅰ期发生骨转移的风险比为1.903;（2）腋窝淋巴结转移数目,发生骨转移的风险比为1.041;（3）确诊时或手术时的年龄,35-50岁患者发生骨转移的风险比为2.132,年龄〉50岁患者发生骨转移的风险比为2.920。结论：乳腺癌骨转移行放射治疗可明显减轻疼痛、改善生活质量,是一种简单有效的治疗方法。初诊时临床分期、腋窝淋巴结转移数目、初诊时年龄是乳腺癌发生骨转移的主要危险因素,明确这些危险因素有利于骨转移的早期发现和采取积极的治疗措施。

Objective ：To investigate the risk factors and radiotherapy effect of bone metastases in breast cancer. Methods：By multivariate analysis of Cox,sproportional hazards regression mode, the risk factors of bone metastases in breast cancer were analyzed in 85 cases. We also retrospectively analyzed the radiotherapy effect in 30 patients with bone metastasis of breast cancer. Results：75% patients obtained complete remission and 85% patients with effective response （complete remission＋partial remission） to radiotherapy. The 1,2 and 3years survival rates were 65%、25% and 5% respectively. The median survival time was 15 months and longer than that of untreated 10 patients（6 months ,P〈0.01）. Multivariate analysis by Cox,sproportional hazards regression model,showed that there were three risk factors of bone metastases in breast cancer： （1） clinical stage ,hazard ratio of bone metastases was 1. 903 for stage Ⅳ vs Ⅰ ;（2）number of invaded axillary lymph nodes,the hazard ratio was 1. 041;（3）age at the time of diagnosis,the hazard ratio was 2. 132 for age 35-50y vs-35 years and 2. 837 for age〉50y VS 40-50y respectively. Conclusion ：Radiotherapy is a simple and effective reatment on bone metastases in breast cancer with pain notably relieves and quality of life promotes. The study indicates that the risk factors of bone metastasis are clinical tage for patients with breast cancer,number of metastatic axillary lymph nodes ,age at the time of diagnosis. It is propitious to diagnose and treat the bone metastases in breast cancer early by identifying these risk factors.