Ⅳ期乳腺癌:65例初诊患者的临床病理特征和预后

Newly diagnosed stage IV breast cancer:Clinicopathological features and prognosis of 65 patients

目的：探讨初诊Ⅳ期乳腺癌患者的临床病理特征、治疗和预后相关因素。方法：回顾性分析2005年1月-2014年11月天津医科大学肿瘤医院收治的65例初诊Ⅳ期乳腺癌患者，分析其临床病理特征、治疗和预后，并进行预后的单因素和多因素分析。结果：65例初诊Ⅳ期乳腺癌患者的中位年龄为53岁（范围：25～82岁），病理类型以浸润性导管癌和浸润性癌为主，原发肿瘤分期以T4分期为主（49．2％）。激素受体阳性者占66．2％（43／65），人表皮生长因子受体2表达阳性者占29．2％（19／65），Ki-67指数≤20％者占23．1％（15／65）。65例患者中，60例（92．3％）以解救化疗作为初治疗法，5例患者先行乳腺原发肿瘤手术后再行解救化疗。随访期间，共21例（32．3％）患者接受了乳腺原发肿瘤手术。65例患者的中位无进展生存时间和中位生存时间分别为8．9和31．8个月。人表皮生长因子受体2表达情况及首发转移部位是无进展生存的独立影响因素（P〈0．05），Ki-67指数和随访期间是否伴随脑转移是影响患者总生存的独立预后因素（P〈0．05）。结论：初诊Ⅳ期乳腺癌患者就诊时原发肿瘤-般较大，预后主要与人表皮生长因子受体2表达情况、Ki-67指数和远处转移部位相关。全身解救化疗是初诊Ⅳ期乳腺癌患者的主要治疗方法，在此基础上可考虑进行乳腺原发肿瘤手术。

Results： The median age at diagnosis of stage IV breast cancer in 65 patients was 53 years （range： 25-82 years）; invasive ductal carcinoma and invasive carcinoma were the most common pathologic types; the tumor size was staged T4 in 49.2% of all the patients. Immunohistochemical results showed that the hormone receptor was positive in 66.2% of the patients （43/65）, human epidermal growth factor receptor-2 （HER-2） was positive in 29.2% of the patients （19/65）, and Ki-67 index was 20% or less in 23.1% of the patients （15/65）. The initial treatment was systemic rescue chemotherapy, accounting for 92.3% （60/65）; the remaining 5 patients underwent surgery for primary breast cancer before systemic rescue chemotherapy. During the period of follow-up, total of 21 patients underwent surgery for the primary breast cancer. The median progression-free survival （PFS） time and median survival time after diagnosis were 8.9 months and 31.8 months, respectively. HER-2 expression and site of first metastasis were independent factors for PFS （P 〈 0.05）. Ki-67 index and brain metastasis during follow-up were independent factors for overall survival （OS） （P 〈 0.05）. Conclusion： The primary tumor size of stage Ⅳ breast cancer at initial diagnosis is generally larger, however the prognosis is mainly related to the expression of HER-2, Ki-67 index and the sites of distant metastases. Systemic rescue chemotherapy is the main treatment for stage Ⅳ breast cancer patients, then the surgery of primary breast cancer could be considered on the basis of systemic rescue chemotherapy.