乳腺癌骨转移的危险因素分析  

Multivariate analysis of bone metastases in breast carcinoma

作　　者：石根明[1] 王跃珍[2] 

机构地区：[1]浙江大学医学院附属第一医院化疗科,杭州310003 [2]浙江省肿瘤医院放疗科

出　　处：《浙江医学》2005年第1期19-22,共4页Zhejiang Medical Journal

摘　　要：目的研究乳腺癌骨转移的主要危险因素。方法采用横断面研究,在杭州市有单光子发射计算机显像检查仪的4家省级医院中,收集1995～2000年进行过全身骨核素显像的乳腺癌住院病人225例的病历资料进行分析研究。结果行骨显像时间从乳腺癌确诊当时至术后294个月,共发生骨转移113例,除去可疑骨转移3例后阳性率50.9%(113?222)。通过多因素Cox逐步回归分析,发现骨转移的主要危险因素有4项:(1)临床分期,Ⅰ～Ⅳ期发生骨转移的风险比为1.945(95%可信限1.396～2.710);(2)腋窝淋巴结转移数目,发生骨转移的风险比为1.039(95%可信限1.011～1.067);(3)局部骨症状或体征是否存在,发生骨转移的风险比为1.722(95%可信限1.060～2.796);(4)确诊时或手术时的年龄,40～50岁患者发生骨转移的风险比为2.084(95%可信限1.122～3.867),年龄>50岁患者发生骨转移的风险比为2.837(95%可信限1.473～5.465)。通过Kaplan-Meier曲线和卡方检验显示腋窝淋巴结转移数目超过5个的患者较腋窝淋巴结转移数目1～5个的患者骨转移的发生率明显增高(P=0.012)。结论手术时临床分期、腋窝淋巴结转移数目、局部骨症状或体征、手术时年龄是乳腺癌发生骨转移的主要危险因素,明确这些危险因素有利于骨转移的早期发现和正确诊断。Objective To investigate the risk factors of bone metastases in breast carcinoma. Methods By cross sectional study,the data were analyzed in 225 breast cancer patients who were inpatients in four hospitals in Hangzhou. All patients underwent total body bone scan with single photon emission computed tomography(SPECT) at least once during 1995 to 2000. Results All patients were followed-up for up to 294 months after operation, bone metastases were found in 113 cases, and 3 cases were undefined with a bone metastases rate of 50.9%(113/222). Multivariate analysis by Cox's proportional hazards regression model, showed that there were four risk factors of bone metastases in breast cancer (1) clinical stage,,hazard ratio of bone metastases was 1.945 (95% CI 1.396～2.710) for stage IV vs I; (2)number of invaded axillary lymph nodes, the hazard ratio was 1.039 (95% CI 1.011～1.067); (3) skeletal complications (yes vs no), the hazard ratio was 1.722 (95% CI 1.060～2.796); (4) age at the time of surgery or diagnosis,the hazard ratio was 2.048(95% CI 1.122～3.867)for age 40～50y vs <40 years and 2.837 (95% CI 1.473～5.465) for age>50y vs 40～50y respectively. Kaplan-Meier curves showed that for patients with >5 axillary lymph nodes, compared with those with 1～5 their bone metastasis rate increased significantly(P=0.012). Conclusion The study indicates that for patients with breast carcinoma the risk factors of bone metastasis are clinical stage, number of metastatic axillary lymph nodes, age at the time of operation and skeletal complications.

关 键 词：骨转移 乳腺癌 危险因素 腋窝淋巴结转移 患者 手术 体征 数目 病历资料 目的 

分 类 号：R737.9[医药卫生—肿瘤]