乳腺癌骨髓转移特点及治疗方法探讨

Characteristics and treatment strategy of bone marrow metastasis in breast cancer

目的探讨乳腺癌患者骨髓转移临床表现的特殊性、转移规律及治疗策略。方法回顾性分析62例女性乳腺癌骨髓转移患者的临床及随访资料,包括乳腺癌骨髓转移发生时间、激素受体状况等及不同治疗策略对预后的影响。24例联合化疗,25例单药化疗,13例未接受化疗。生存率用Kaplan-Meier方法计算,用Log-rank方法进行生存曲线比较。结果62例患者中位年龄39岁(30～71岁),中位病程21个月(1～49个月)。雌激素受体(ER)和(或)孕激素受体(PR)阳性患者30例(48.4%),阴性19例(30.6%)。发热14例(22.6%)和(或)血象的一系或三系降低34例(62.9%)是乳腺癌骨髓转移的常见表现。联合化疗和单药化疗中位生存期分别为10个月和16个月(QPH=7.38,P=0.0335),未接受化疗者中位生存期仅1个月。骨髓转移发生偏晚,一般有多处转移尤其是骨转移的背景。结论骨髓穿刺有利于早期发现骨髓转移;骨髓转移晚期体质较弱,单药化疗可能是有效的治疗策略之一,与联合化疗组的患者相比具有生存优势。

Objective To investigate the clinical characteristics, rule of metastasis, and treatment strategies of bone marrow metastasis in patients with breast cancer. Methods Data of clinical manifestation and follow-up for 62 patients with bone marrow metastasis were analyzed retrospectively. The data included the time of occurrence of the bone marrow metastasis, hormone receptor status and effect of different treatment strategies on the prognosis. Patients were divided into 3 groups： group A （n=24）, group B （n=25）, and group C （n=13）. Group A underwent combined chemotherapy; group B single-agent chemotherapy; and group C no chemotherapy. The survival rate was calculated by Kaplan-Meier method, and the survival curve was compared according to Log-rank test. Rusults The median age of the patients （n=62） was 39 （from 30 to 71）; the median course of disease was 21 （from 1 to 49） months. For the expression of estrogen receptor （ER） and/or progesterone receptor （PR）, 30 patients showed positive results （48.4%）, and 19 showed negative results （30.6%）. Commonly seen clinical manifestations of bone marrow metastasis were fever which appeared in 14 patients （22.6%） and the decrease of 1 or 3 indexes in hemogram which occurred in 34 patients （62.9%）. The median survival period of group A was 10 months and that of group B was 16 months, but that of group C was merely 1 month （QPH=7.38, P=-0.0335）. Bone marrow metastasis occurred in the late stage of breast cancer, and often after multimetastasis, especially bone metastasis. Conclusion Bone marrow aspiration can help discover the metastasis in the early stage. On an account that the patients with bone marrow metastasis in a later stage are weak, single-agent chemotherapy might be one of the most effective treatment strategies. In comparison with combined chemotherapy, single-agent chemotherapy has the advantage of a longer survival period.