乳腺癌单纯骨转移患者预后相关因素分析

Prognostic factors for patients with bone-only metastasis in breast cancer

目的乳腺癌患者的单纯骨转移发生率较低。本研究旨在探讨影响乳腺癌单纯骨转移患者预后的因素。方法回顾性分析解放军307临床学院肿瘤中心2012-01-01-2015-12-31收治的96例乳腺癌单纯骨转移患者临床资料,采用Kaplan-Meier法和Cox回归分析,分析影响乳腺癌单纯骨转移患者预后的相关因素。结果乳腺癌单纯骨转移患者骨转移后中位生存时间为45个月(95%CI:29.4~60.6),中位骨外无进展时间为22个月(95%CI:15.6~28.4)。单因素分析显示,肿瘤大小、术后腋窝淋巴结转移数目、Ki-67、术后无病生存期(disease-free survival,DFS)、解救放疗、解救内分泌治疗与单纯骨转移患者骨外转移的发生有显著相关性。而肿瘤大小、激素受体状况、骨转移数目、术后DFS、内分泌治疗与单纯骨转移后生存期有显著相关性。通过Cox多因素回归分析发现,Ki-67(P=0.037)和解救放疗(P=0.029)是乳腺癌单纯骨转移患者发生骨外转移的主要影响因素,骨转移灶数目(P=0.003)和解救内分泌治疗(P=0.017)是影响单纯骨转移患者生存期的主要因素。而激素受体阳性单纯骨转移患者中,术后DFS(P=0.032)、骨转移灶数目(P=0.004)和解救内分泌治疗(P=0.018)是影响患者生存期的主要因素。结论 Ki-67高表达是乳腺癌单纯骨转移患者发生骨外转移的独立危险因素,解救放疗可能延缓骨外转移的发生。单发骨转移是乳腺癌单纯骨转移患者的独立良好预后因素。内分泌治疗能够改善激素受体阳性乳腺癌单纯骨转移患者骨转移后生存。

OBJECTIVE The previous studies showed a low incidence of bone-only metastasis in breast cancer patients.The purpose of this study was to define the prognostic factors affecting survival following bone-only metastasis in breast cancer patients.METHODS All women（n=96）diagnosed with bone-only metastasis from breast cancer between2012-2015 at 307 th Hospital of PLA were studied retrospectively.RESULTS The median time from the diagnosis of bone-only metastasis to the last follow-up or death was 55.2 months（95%CI=29.4-60.6）.The median time from the diagnosis of bone-only metastasis to the extra-bone metastasis or death was 22 months（95%CI=15.6-28.4）.Patients with Ki-67≤14%（P=0.037）or radiotherapy（P=0.029）for bone metastasis had a longer extra-bone progression-free survival（EB-PFS）,and patients with a solitary bone metastasis（P=0.003）or endocrine therapy（P=0.017）had a longer overall survival after diagnosis of bone metastasis（BM-OS）.Among patients with hormone receptor（HR）＋tumors,longer recurrence-free interval（RFI）（P=0.032）,solitary bone metastasis（P=0.004）and endocrine therapy（P=0.018）were significantly associated with longer BM-OS.CONCLUSION The results indicate that endocrine therapy could prolong overall survival after diagnosis of bone metastasis in patients with HR（＋）tumors.