146例乳腺癌首发肝转移患者的临床病程与预后多因素分析

Clinical course and potential prognostic factors of 146 breast cancer patients with liver metastasis

目的探讨乳腺癌首发肝转移的临床病程、治疗效果及预后影响因素。方法收集2005～2010年中国医学科学院肿瘤医院收治、首发转移部位为肝脏的女性乳腺癌患者的临床病理资料及生存情况,回顾性分析其预后及影响因素。结果全组146例患者,术后中位无病生存期(DFS)19.1个月,转移后中位生存期(MSR)22个月,中位无进展生存期(PFS)9个月。肝转移后1、2、3年生存率分别为69.8%、43.4%和31.7%。整组初始治疗的有效率为59.4%,临床获益率为84.4%。单因素分析显示:原发肿瘤的大小、激素受体状态、是否为三阴性乳腺癌、无病生存期长短、有无其他脏器转移、肝转移灶数目、肝转移时转氨酶、转移后首次治疗方式以及一线治疗疗效与预后有关。多因素分析显示是否三阴性乳腺癌及无病生存期长短是影响乳腺癌肝转移后生存的独立预后因素(P=0.006,P=0.008)。结论乳腺癌肝转移患者经过合理的综合治疗后,其生存期及1、2、3年生存率较前有显著提高,术后无病生存期短以及三阴性亚型的乳腺癌肝转移患者预后较差,需要更精细和个体化的治疗以改善预后。

Objective To investigate the clinical course, efficacy of treatment, prognosis and relevant influencing factors of breast cancer patients with liver metastasis. Methods Female breast cancer patients who had liver as their first site of metastases and were treated in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College during 2005 - 2010 were taken retrospectively into the study. The clinical, pathological and survival data of them were collected for prognostic analysis. Results The median diseases free survival （ DFS ） , progression free survival （ PFS ） and post metastasis survival （MSR） of the whole group was 19. 1 months, 9 months and 22 months respectively. The survival rates decreased yearly, with 69.8% of the first year, 43.4% and 31.7% of the following two years. The response rate of the whole group was 59.4% , while the clinical benefit rate was 84. 4% , showing a comparative good response towards treatment. Multivariate analysis suggested the subtype of triple negative breast cancer and the short interval of disease free survival were independent predictors of poor survival after liver metastases （ P = 0. 006. P = 0. 008, respectively）. Conclusion Due to the current comprehensive treatment, the survival of breast cancer patients with live metastasis has been evidently improved. However, those with triple negative phenotype or with quick metastasis to liver still experience a poor outcome and therefore call for a more appropriate way of treatment.