转移性三阴乳腺癌的临床特征和治疗结果

Clinicopathological features and treatment outcomes for patients with metastatic triple-negative breast cancer

目的 分析转移性三阴乳腺癌的临床病理特征、生存情况和局部治疗在转移性三阴乳腺癌中的作用.方法 回顾分析1998-2013年间收治的220例转移性三阴乳腺癌患者的临床特征和治疗结果.全组206例初诊Ⅰ～Ⅲ期患者治疗后出现远处转移（186例接受改良根治术、14例保乳手术＋放疗、5例单纯保乳术、1例未接受手术;化疗196例,88例改良根治术后局部区域放疗）,14例Ⅳ期初诊时即有远处转移（8例接受改良根治术、1例区段切除术、5例未接受手术）.用Kaplan-Meier法计算生存率,Logrank法检验和单因素预后分析转移后治疗对生存的影响.结果 最常见转移部位为肺和骨,实质性脏器转移182例（82.7％）,单器官转移63例（28.6％）,多器官转移153例（69.5％）,4例不详.三阴乳腺癌初诊3年内转移达高峰,5年后很少发生转移（6.4％）.中位随访时间22个月,全组转移后5年OS为25.0％,中位生存时间21个月.单器官转移、多器官转移的5年OS分别为38.2％、17.5％（P =0.005）.合并内脏转移、局限骨转移的5年OS分别为20.3％、56.2％（P =0.049）.62例单器官转移病例中接受手术或放疗局部治疗组和无局部治疗组的转以后5年OS分别为48％和29％ （P =0.006）.结论 转移性三阴乳腺癌常见内脏实质器官转移,单器官转移预后好于多器官转移;对于单一器官转移,挽救性局部治疗能改善生存;局限于骨转移好于合并内脏转移预后.

Objective To analyze the clinicopathological features and survival of patients with metastatic triple-negative breast cancer （TNBC） and the value of locoregional treatment for metastatic TNBC.Methods A retrospective analysis was performed on the clinical features and treatment outcomes of 220 patients with metastatic TNBC admitted from 1998 to 2013.Of them,206 patients with stage Ⅰ-Ⅲ disease developed metastasis disease after treatment （186 patients undergoing modified radical mastectomy,14 patients undergoing breast-conserving surgery plus radiotherapy,5 patients undergoing breast-conserving surgery alone,and one patient not undergoing surgery; 196 patients receiving chemotherapy,and 88 patients receiving locoregional radiotherapy after modified radical mastectomy）,and 14 patients presented stage Ⅳ disease （8 patients undergoing modified radical mastectomy,one patient undergoing segmental mastectomy,and 5 patients not undergoing surgery）.Overall survival （OS） and progression-free survival were calculated by the Kaplan-Meier method; the log-rank test and univariate prognostic analysis were used to assess treatment outcomes.Results The most common metastatic sites were the lung followed by bones.Of all patients,182 （82.7%） developed visceral organs metastasis.Sixty-three （28.6%） developed metastasis to a single organ,whereas 182 （69.5%） with multiple metastatic disease and 4 patients were unclear.Most patients developed distant metastasis within 3 years after the initial diagnosis of TNBC,and only 6.4% of all patients developed distant metastasis over 5 years later.With a median follow-up of 22 months,the 5-year OS was 25.0%,and the median survival time was 21 months.The 5-year OS of patients with single metastasis was 38.2%,compared with 17.5% for those with multiple metastases （P =0.005）.The 5-year OS of patients with visceral organ metastasis was 20.3%,compared with 56.2% for those with metastasis in bones （P =0.049）.For 63 patients with single metastasis,those receiving locoregional treatment with radiotherapy or surgery had a significantly increased OS compared with those receiving no locoregional treatment （48% vs 29%,P =0.006）.Conclusions Patients with metastatic TNBC usually present with visceral metastasis.Patients with single metastasis have a better outcomes than those with multiple metastases.Patients with metastasis in bones have a better autcomes than those with visceral organs involved.Locoregional treatment significantly improved the overall survival in patients with single metastasis.