首发中枢神经系统转移的乳腺癌患者临床特点分析

Clinical Characteristics of Breast Cancer Patients with Central Nervous System Metastasis

目的 探讨首发中枢神经系统转移的乳腺癌患者的临床特点及预后影响因素。方法 回顾性分析51例以中枢神经系统转移为首发转移的乳腺癌患者的临床病理资料及生存情况及影响预后的因素。结果 全组51例患者,转移后中位生存时间6个月,1年、2年、3年总生存率分别为21.57%（11/51）、2.00%（8/40）、0（32/32）。整组初始治疗的有效率为49.01%（25/51）。单因素分析显示临床分期（χ2=6.586,P=0.045）、HER2过表达型（χ2=4.018,P=0.042）、三阴型（χ2=8.426,P=0.004）是转移的相关危险因素,多因素分析显示免疫组化三阴性是独立危险因素（χ2=6.964,P=0.008）。治疗方式（χ2=8.407,P=0.019）、首次治疗后疗效（χ2=8.324,P=0.010）是影响预后的危险因素。结论 分期晚、三阴性乳腺癌患者应重视中枢神经系统的转移,而且先放疗获益较大。

Objective To investigate the clinical characteristics, prognosis and relevant influencing factors of breast cancer patients with parasympathetic nervous system metastasis. Methods Clinical, pathological and survival data and prognos- tic factors of 51 case of breast cancer patients who had parasympathetic nervous system as their first site of metastases were ana- lyzed retrospectively. Results The median survival time was 6 months, 1-,2- and 3-year survival rates were 21.57 % （11/51）, 2.00% （8/40） ,0（ 32/32 ）, respectively. The treatment response rate of the whole group was 49.01% （25/51）. Univariate analy- sis showed that TNM stage（x2 =6.586,P =0. 045）,subtype of HER-2 over-expression（ X2 =4. 018,P =0. 042） ,subtype of tri- ple negative（ X2 --8. 426 ,P = 0.004）were risk factors. Multivariate analysis suggested that subtype of triple negative breast cancer was independent risk factor（ X2 = 6. 964, P = 0. 008 ）, therapeutic methods （ X2 = 8. 407, P = 0. 019 ） and the first curative effect （ X2 = 8. 324, P = 0.010 ） were prognostic factors. Conclusion Advanced stage breast cancer with the subtype of triple negative or the stubtype of HER-2 over-expression should pay attention to parasympathetic nervous system metastasis, and the survival of breast cancer patients can benefit from radiation therapy greatly.