晚期乳腺癌原发病灶切除对患者预后的影响

Effect of primary lesion resection on the prognosis of patients with advanced breast cancer

目的探讨原发灶切除对Ⅳ期乳腺癌患者预后的影响。方法将2008年6月至2015年6月在河北医科大学第四医院首诊为Ⅳ期的132例乳腺癌患者分为原发灶切除组(85例)和原发灶未切除组(47例),分析原发灶切除、手术时机选择、淋巴结摘除与清扫、是否放疗对Ⅳ期乳腺癌患者预后的影响。结果多因素Logistic回归分析显示,内脏转移是Ⅳ期乳腺癌患者原发灶切除的独立影响因素(OR=2.590,95%CI为1.090~6.159)。多因素Cox回归分析显示,原发灶切除是Ⅳ期乳腺癌患者预后改善的独立影响因素(OR=0.582,95%CI为0.400~0.847)。原发灶切除组中位总生存时间(OS)为37.20个月,高于原发灶未切除组(24.10个月;χ^(2)=8.108,P=0.004)。在年龄≥50岁的患者中,原发灶切除组和原发灶未切除组中位OS分别为39.30和23.03个月,差异有统计学意义(χ^(2)=14.191,P<0.001)。确诊至原发灶切除手术时间<6个月组(66例)和≥6个月组(19例)患者的中位OS分别为38.00和35.20个月,差异有统计学意义(χ^(2)=4.430,P=0.035)。单侧腋窝淋巴结清扫组与腋窝淋巴结摘除组患者的中位OS分别为45.37和33.44个月,差异有统计学意义(χ^(2)=7.832,P=0.005)。术后放疗组和未放疗组患者的中位OS分别为44.80和33.20个月,差异无统计学意义(χ^(2)=2.950,P=0.086)。结论部分晚期乳腺癌患者切除原发灶可延长其生存时间。

Objective To explore the effect of the resection of the primary lesion on the prognosis for patients with stageⅣbreast cancer.Methods A total of 132 breast cancer patients who were first diagnosed as stageⅣin the Hebei Cancer Hospital from June 2008 to June 2015 were divided into two groups:the primary resection group(n=85)and the unresection group(n=47).The influences of primary resection,timing of operation,lymph node removal or dissection and radiotherapy on the prognosis of stageⅣbreast cancer patients were analyzed.Results Multivariate Logistic regression analysis showed that visceral metastasis was an independent influencing factor for primary lesion resection in stageⅣbreast cancer patients(OR=2.590,95%CI:1.090-6.159).Multivariate Cox regression analysis showed that primary resection was an independent factor for the improvement of prognosis in stageⅣbreast cancer patients(OR=0.582,95%CI:0.400-0.847).The median overall survival(OS)was 37.20 months in the resection group,which was higher than 24.10 months in the unresection group(χ^(2)=8.108,P=0.004).Among patients aged≥50 years old,the median OS was 39.30 months in the resection group and 23.03 months in the unresection group,and the difference was statistically significant(χ^(2)=14.191,P<0.001).The median OS was 38.00 months in the 66 patients with the operation time from diagnosis to resection of primary lesion<6 months(n=66),and 35.20 months for≥6 months(n=19)(χ^(2)=4.430,P=0.035),the difference was statistically significant(χ^(2)=4.430,P=0.035).The median OR of axillary lymph node dissection and axillary lymph node excision group were 45.37 months and 33.44 months,respectively,the difference was statistically significant(χ^(2)=7.832,P=0.005).The median OS of postoperative radiotherapy group and non-radiotherapy group were 44.80 months and 33.20 months,respectively,the difference was not statistically significant(χ^(2)=2.950,P=0.086).Conclusion Resection of the primary lesion may prolong the survival time of some advanced breast cancer patients.