乳腺原发骨肉瘤-24例个案汇总分析

Primary osteogenic sarcoma of the breast:a pooled-analysis of 24 cases

目的增加临床医师对乳腺原发骨肉瘤(POB)临床诊治的认识。方法通过PubMed进行文献搜索,关键词使用英文"osteosarcoma"和"breast",搜集2003—2016年间公开发表的相关个案报道进行汇总,回顾性分析24例POB患者的病历资料,探讨POB的临床特点、治疗和预后影响因素。计数资料的组间比较采用Fisher精确概率法检验;采用Kaplan-Meier法计算生存率,组间比较采用Log-rank检验;多因素分析采用Cox逐步回归模型。结果本研究共纳入24例POB患者,年龄24~87岁,中位年龄62岁,其中,1例患者在22年前因同侧乳腺癌接受过放射治疗。乳腺肿块直径为1.4~25.0 cm,中位直径5.0 cm,3例患者就诊时存在乳腺外转移。24例POB患者中,6例患者接受了肿块完整切除,18例患者接受了全乳切除。8例腋窝临床检查阴性的患者接受腋窝淋巴结解剖,病理均未发现转移。全组死亡患者9例,按照AJCC骨肉瘤分期,Ⅰ期、Ⅱ期和Ⅳ期POB患者生存率比较,差异有统计学意义(χ2=15.205,P=0.000)。单因素分析结果显示,肿块直径﹥10 cm、组织学高级别和初诊Ⅳ期是POB患者生存的不良预后因素(P﹤0.05);多因素分析结果显示,仅组织学高级别是POB患者生存的独立预后因素(P=0.032)。结论 POB较为罕见,通常以血行转移为主,淋巴结转移少见。治疗上推荐肿瘤完整切除,不需要常规进行腋窝解剖。组织学高级别是其独立的预后不良因素。

Objective To strengthen the clinicians＇ understanding of the diagnosis and treatment of primary osteosarcoma of the breast（POB）. Method Using ＂breast＂ and ＂osteosarcoma＂ as key words, literature search was performed through Pub Med. Relevant case reports published between 2003 and 2016 were collected and summarized. The clinical data of 24 POB patients was analyzed retrospectively and the clinical features, optimal treatment and prognostic factors of POB were explored. Fisher＇s exact-test were applied to estimate the differences in baseline characteristics. Survival rates were calculated with Kaplan-Meier methods and compared with Log-rank tests. Multivariate analysis were analyzed by Cox proportional hazards regression model. Result Twenty-four cases of POB, aged between 24-87（median, 62） were included, in which one patient received radiotherapy for ipsilateral breast carcinoma 22 years ago. The diameter of neoplasms were ranged from 1.4 cm to 25.0 cm（median, 5.0 cm）. Three patients had extramammary spread at diagnosis. Patients were treated by tylectomy（n=6） or mastectomy（n=18）. 8 patients with clinically negative axillary nodes were administered with dissection, while there were no metastases observed. Nine patients died of disease. The difference in overall survival（OS） rate was statistically significant between stage I, II, and IV disease in POB patients according to AJCC staging system for osteosarcoma（χ^2=15.205, P=0.000）. The results of univariate analysis showed that T〉10 cm, high histological grade and stage IV disease were significantly associated with decreased OS（P〈0.05） and multivariate analysis revealed that only high histological grade was the independent prognostic factor of OS（P=0.032）. Conclusion POB is relatively rare with a propensity for blood-borne rather than lymphatic spread. Radical resection without routine axillary dissection is advised. High histological grade is an independent prognostic factor.