Ⅳ期乳腺癌原发肿瘤手术治疗的研究进展

Research progress about resection of primary tumor in breast cancer of stage Ⅳ

目的总结原发肿瘤手术在Ⅳ期乳腺癌治疗中的作用。方法检索近年来国内外有关Ⅳ期乳腺癌原发肿瘤手术治疗的回顾性及前瞻性研究,并进行综述。结果回顾性研究的结果大都得出了Ⅳ期乳腺癌患者可以从手术中获益的结论,但回顾性研究存在不可避免的偏倚:入组患者的年龄较为年轻、肿瘤较小、分组不能随机等,导致其结果存疑。国外几项前瞻性研究的结果不一致,其中MF07-01研究得出了手术可以获益的结论,并发现激素受体阳性、人表皮生长因子受体2阴性、年龄<55岁以及单纯骨转移的患者的死亡风险更低;其他研究则得出不同结论。国内几项回顾性研究也得出了Ⅳ期乳腺癌患者可以从手术中获益的结论。结论Ⅳ期乳腺癌原发肿瘤手术可以使部分患者获益,但需要更多前瞻性研究来筛选出可以获益的患者特点。

Objective To discuss the role of primary tumor resection in breast cancer of stage Ⅳ. Methods To search and review retrospective and prospective clinical trials about primary tumor resection in breast cancer of stage Ⅳin recent years at home and abroad. Results The results of most retrospective clinical trials were that primary tumor resection in breast cancer of stage Ⅳ was beneficial. But there were some obvious bias: younger patients, smaller tumors,non-randomized design, and so on. The results of several prospective studies abroad were inconsistent. In the MF07-01,hazard of death was lower in the surgery group and subgroup analysis showed that the risk of death was lower in the surgery group with respect to positive-hormone receptor, negative-human epidermal growth factor 2, patients younger than 55 years, and patients with solitary bone-only metastases when other prospective studies come to the different conclusions. Several Chinese retrospective studies also had similar results that primary tumor resection was beneficial.Conclusion Primary tumor resection in breast cancer of stage Ⅳ can benefit some patients, whom need more prospective studies to choose.