手术切除原发病灶对转移性乳腺癌的疗效分析

A comparative analysis of surgical treatment to primary tumor in patients with metastatic breast cancer

目的：对转移性乳腺癌原发病灶是否行手术切除目前并未形成共识，本研究是通过分析转移性乳腺癌患者的临床资料，评价本组资料手术和非手术治疗方法的优劣。方法：收集2005年1月至2012年12月收治的120例原发性乳腺癌同时伴有远处转移患者的临床资料，将其分为手术组和非手术组，分析两组总体生存率和局部病灶进展情况，并进行统计学分析。结果：120例患者均获得随访，随访的中位时间为52（10～92）个月。手术组共55例，其中30例为术后围手术期内发现远处转移，非手术组65例。两组患者的肿瘤局部分期、淋巴结分期、肿瘤转移的部位差异均无统计学意义。与非手术组患者相比，手术组总体生存时间明显延长（49个月vs.33个月，P=0.016），有症状的局部病情进展比例明显降低（14.5%vs.46.2%，P〈0.001）。结论：研究结果显示，对于转移性乳腺癌患者，切除原发病灶可有助于提高总体生存时间，延缓病情进展。但此结论仍需要多中心的临床研究结果证实。

Objective：Until recently, no consensus has been reached about the treatment of primary tumor in patients with meta-static breast cancer, and whether or not to excise it has not yet reached agreement. This study aimed to evaluate the value of surgical and nonsurgical treatment of primary tumor by analyzing the clinical data of patients with metastatic breast cancer. Methods：This re-view includes the data of 120 metastatic breast cancer patients. Their clinical data in Xiangyang Central Hospital （Hubei province） from January 2005 to December 2012 were collected. All cases were divided into surgical and nonsurgical groups, and the overall survival and symptomatic local progression rates were analyzed. Results：The 120 patients had a median follow-up of 52 months （range=10-92 months）. A total of 55 cases were in the surgical group, 30 of whom had surgery before the metastatic diagnosis, and 65 cases were in the nonsurgical group. No significant differences were observed regarding the tumor classification, lymph-node classification, and meta-static site of the tumor in the two groups. Patients in the surgical group experienced longer overall survival （49 months vs. 33 months, P=0.016） and lower rates of symptomatic local progression （14.5%vs. 46.2%, P〈0.001）. Conclusion：This study demonstrated that the overall survival and symptomatic local control in the surgical group were better than those in the nonsurgical group. However, this hy-pothesis remains to be proved by multicenter clinical trials.