乳腺癌患者早期骨转移的危险因素分析

Risk factors of early bone metastasis in breast cancer patients

目的探讨乳腺癌患者术后2年内发生早期骨转移的危险因素。方法回顾性分析2008年1月至2016年12月在南京医科大学第一附属医院就诊的146例乳腺癌骨转移患者资料。采用Kaplan-Meier生存曲线及log-rank检验比较不同年龄、原发肿瘤大小、腋窝淋巴结转移数目及分子分型的乳腺癌患者无骨转移时间(BFT)的差异。采用Cox比例风险回归模型分析乳腺癌早期骨转移的危险因素。结果146例乳腺癌骨转移患者中位BFT为25.9个月(范围:0.1~201.3个月)。确诊乳腺癌的年龄≥59岁、肿瘤分期T2及以上、腋窝淋巴结转移数目≥10枚均为乳腺癌早期骨转移的危险因素(χ^2=18.42,P<0.001;χ^2=21.71,P<0.001;χ^2=30.79,P<0.001)。患者年龄≥59岁、肿瘤分期T2及以上、腋窝淋巴结转移数目≥10枚均为乳腺癌早期骨转移的独立危险因素(HR=2.392,95%CI:1.367~4.184,P=0.002;HR=2.159,95%CI:1.061~4.393,P=0.034;HR=1.964,95%CI:1.167~3.305,P=0.011)。结论高龄、原发肿瘤直径大、腋窝淋巴结转移数目多的乳腺癌患者更易发生早期骨转移。

Objective To explore the risk factors of early bone metastasis in breast cancer patients within postoperative two years.Methods The clinical data of 146 breast cancer patients with bone metastasis in the First Affiliated Hospital of Nanjing Medical University from January 2008 to December 2016 were analyzed retrospectively. The Kaplan-Meier survival curve and log-rank test were used to compare the bone metastasis-free time (BFT) among patients with different ages, tumor sizes, metastatic lymph node numbers and molecular subtypes. Cox’s proportional hazards regression model was used to analyze the risk factors of early bone metastasis.Results In 146 breast cancer patients with bone metastasis, the median BFT was 25.9 months (range: 0.1-201.3 months). Age ≥59 years (χ^2=18.42, P<0.001), tumor stage≥T2 (χ^2=21.71, P<0.001), metastatic lymph nodes≥10(χ^2=30.79, P<0.001)were risk factors of early bone metastasis in breast cancer patients. Age≥59 years, tumor stage≥T2 and metastatic lymph nodes≥10 were identified as independent risk factors of early bone metastasis in breast cancer patients (HR=2.392, 95%CI: 1.367-4.184, P=0.002;HR=2.159, 95%CI: 1.061-4.393, P=0.034;HR=1.964, 95%CI: 1.167-3.305, P=0.011).Conclusion The breast cancer patients with higher age, larger diameter of primary tumor or more metastatic axillary lymph nodes are more prone to early bone metastasis.