乳腺癌特殊部位转移68例临床特征及预后分析

Analysis of clinical features and prognosis of breast cancer with uncommon metastases

目的 :分析特殊部位转移的乳腺癌的临床病理特征及预后。方法 :回顾性分析2012—2015年68例伴特殊部位转移的乳腺癌患者的临床资料。特殊转移部位的定义:除淋巴结、胸壁、乳腺、骨、肝、肺、脑、腹膜和胸膜转移以外的少见转移部位。结果:68例患者中,最常见的特殊转移部位依次为肾上腺(44.1%,30/68)、卵巢(41.2%,28/68)和胰腺(11.8%,8/68),其余包括眼、子宫、脾、直肠、膀胱、肾、甲状腺和腮腺等。75.0%(51/68)的患者伴有其他常见部位的转移。特殊部位转移后的中位生存时间为23.5个月(范围:1.4~116.0个月),不伴有常见部位转移患者的中位生存时间与伴有常见部位转移患者相比,前者显示出生存优势(分别为36.0和18.0个月,P=0.007)。结论 :乳腺癌转移部位广泛,除常见转移部位以外,还可以转移至许多少见部位;不伴有常见部位转移的特殊部位转移乳腺癌患者的预后较好,因此有选择性地进行局部治疗可能会改善生存;卵巢转移大多于去势手术时发现,临床上在选择卵巢去势方式时,应考虑卵巢转移的可能性。

Objective： To analyze the clinical pathological characteristics and prognosis of breast cancer patients with uncommon metastases. Methods： Clinical data of 68 cases of breast cancer with uncommon metastases from 2012 to 2015 was retrospectively analyzed. The definition of uncommon sites of metastases is the metastatic sites except for lymph node, chest wall, breast, bone, liver, lung, brain and peritoneal and pleural metastases. Results： Among the 68 patients, the uncommon metastatic sites included adrenal gland, ovary, pancreas, eyes, uterus, spleen, rectum, bladder, kidney, thyroid gland and parotid gland. The top three common metastatic sites were adrenal gland （44.1%, 30/68）, ovary （41.2%, 28/68） and pancreas （11.8%, 8/68）; 75.0% （51/68） of the patients had other common metastases. The median survival time after uncommon metastases was 23.5 months （range：1.4-116.0 months）. The univariate analysis showed that the patients without metastases outside the special sites had a better survival than those with common metastases （median survival time were 36.0 and 18.0 months, respectively; P=0.007）. Conclusion： Breast cancer metastasis is widespread, in addition to the common sites, the cancer can be transferred to many other sites. Patients with uncommon metastases from breast cancer may have a favorable prognosis if they do not accompany with other common metastases, and local treatment may improve the survival of some selected patients. Many ovarian metastases are found after the operation, and the possibility of ovarian metastasis should be considered in the selection of the method of ovarian ablation.