乳腺癌术后食管转移情况的Meta分析

Breast cancer metastatic to the esophagus:a Meta analysis

目的探讨乳腺癌术后食管转移临床特点、诊断及治疗。方法检索1989年至2011年期间文献报道的乳腺癌术后食管转移病例,分析其临床数据和生存资料。结果共检索到乳腺癌术后食管转移报道病例28例。发病中位年龄67(41～83)岁;乳腺癌术后距食管转移的中位间隔时间10.5年(3.5～24年);除1例(3.6%)表现为呕血外,其余27例(96.4%)均表现以进行性加重的吞咽困难;GI检查显示转移部位发生在食管胸中段15例(53.6%)、胸中下段2例(7.1%)、胸下段8例(28.6%)、食管胃结合部3例(10.7%);食管转移灶有免疫组化检测结果的共11例(39.3%),均显示ER(+)和(或)PR(+);发生食管转移后的治疗方法包括化疗、内分泌治疗、放疗以及食管扩张、食管支架置入、姑息性手术等。28例中有详细生存资料的共22例(78.6%),其中15例死亡,7例仍存活,22例的中位总生存时间为18(1～96)个月,1、3、5年生存率分别为54.5%、27.3%、9.0%。结论对于有乳腺癌病史,特别是病史较长或伴有高危复发因素的患者,出现吞咽困难症状时首先要考虑乳腺癌食管转移的可能。

Objective We report the 28 cases of breast cancer metastasis to the esophagus and explore the pathogenesis ,diagnosis and treatment. Methods Twenty-eight female patients with breast cancer metastasis to the esophagus reported in the literature were retrieved（ 1989 -2011 ）. Results Twenty-eitht patients with median age of 67 （range： 41 -83 ） years had median time of 10.5 （3.5 -24） years between primary breast cancer diag- nosis and esophagus metastasis. All but one presented with progressive dysphagia. The sites of metastatic lesions in the middle esophagus were 15（53.6% ） eases, in the mid-lower esophagus were 2 cases（7.1% ）, in the lower esophagus were 8 （ 28.6% ） cases and in the esophagogastrie junction were 3 cases （ 10.7 % ）. Endoscopic biopsy/ cytology were negative for cancer in 16 of 18 cases. Immunohistochemical staining was done in 11 cases（ ER and/ or PR positive ）. Treatment included hormonal therapy, chemotherapy theraphy, radiotheraphy, dilatation and stent, palliative surgery,etc. Among 28 cases, 22 cases had detailed survival data, and 7 of 22 cases were still a- live, The median survival time was 18 （range： 1 -96） months, 1-, 3-, and 5-year survival rates were 54.5%, 27.3% and 9%, respectively. Conclusions The onset of dysphagia in patients with a history of breast cancer should prompt the clinician to rule out the possibility of esophagus metastasis, especially in the patients with lon- ger duration from original breast cancer or factors associate with high risks of recurrence and metastasis.