163例乳腺癌肝脏转移临床资料和预后因素分析  

Management and prognosis of liver metastasis in breast cancer patients : a report of 163 cases

作　　者：李杰[1] 徐向东[1] 邵楠[1] 林颖[1] 李晓曦[1] 王深明[1] 吕伟明[1] 

机构地区：[1]中山大学附属第一医院甲状腺乳腺外科,广州510080

出　　处：《岭南现代临床外科》2016年第5期574-579,共6页Lingnan Modern Clinics in Surgery

基　　金：广东省科技计划项目(2016A040403049);广东省科技计划项目(2013B010404015);广东省医学科研基金项目(A2014220)

摘　　要：目的探讨乳腺癌肝脏转移的临床特点、治疗情况以及预后。方法回顾性分析2006年1月至2016年1月中山大学附属第一医院收治的乳腺癌肝脏转移病例,总结该部分患者的临床病理特征、治疗方式、生存期以及影响预后的因素。结果共163例患者入组,其中初诊合并肝脏转移69例(A组),乳腺癌术后复发累及肝脏94例(B组)。所有患者均行以全身治疗为主的综合治疗,其中35.6%的患者行手术、消融或TACE局部治疗。B组患者中位生存时间较A组患者延长12.0个月(P=1.83×10^(-10)),相应的1年、2年、3年生存率也明显高于A组(A组:1年79.44%,2年40.54%,3年9.20%;B组:1年98.94%,2年84.92%,3年40.54%)。而有机会局部治疗的患者生存期明显延长:局部治疗组中位生存时间为33.0个月(95%CI,30.0~39.4个月),未能局部治疗组中位生存时间仅为26.4个月(95%CI,23.6~29.7个月),(P=9.95×10^(-3))。单因素分析显示激素受体状态、HER-2表达情况、Ki67增殖情况、分子分型、肝脏多发转移灶是否局限以及是否有机会局部治疗均与乳腺癌肝脏转移患者的预后相关。多因素分析则提示HER-2表达情况、肝脏多发转移灶是否局限以及是否有机会局部治疗是乳腺癌肝脏转移患者的独立预后因素。结论乳腺癌肝脏转移一旦发生,预后较差。临床工作中应注重乳腺癌患者的肝脏筛查,以期早期发现、早期治疗。治疗应以全身综合治疗为主,对于孤立的单一转移灶或局限的多发转移灶,局部治疗可以取得良好的效果。Objective To assess the clinical characteristics, treatment and prognostic factors of liver metastasis in breast cancer patients. Methods One-hundred and sixty-three breast cancer patients with liver metastasis were included in this study from January 2006 to January 2016. The clinical, pathological and treatment information was collected, and the factors related to the survival were evaluated.. All statistical analyses were performed using R software. Results The median overall survival of breast cancer with liver metastases was 29.5 （95%CI： 27.8-31.7） months, the median overall survival Group A （initial Stage IV patients with liver metastases） was 22.1 （95%CI： 17.8- 25.1） months, while the median overall survival Group B （relapse with liver metastases） was 34.1 （95%CI： 30.6-37.6） months （P=1.83×10^-10）. If the patients had opportunity to perform local therapy, the prognosis became much better： the median overall survival extended from to 26.4 months to 33.0 months （P=9.95×10^-3）; 1 years, 2 years, 3 years survival rate in Group B are also significantly higher than Group A （Group A： 79.44%, 40.54%, 9.20%; Group B： 98.94%, 84.92%, 40.54% ）.In univariate analysis, the factors of hormone receptor status, Her-2 expression, Ki67 proliferation, molecular classification, whether multiple liver metastases were limited, and local therapy opportunity were associated with the prognosis of breast cancer patients with liver metastasis （P〈0.05）. In muhivariate analysis, the factors of high Her-2 expression, multiple liver metastases were not limited, and no opportunity to do local therapy were independent predictors of poor survival after lung metastases （P〈0.05）. Conclusion The prognosis of breast cancer patients with liver metastasis is poor. We should pay more attention to the liver screening in order to early detection and early treatment. The preferred treatment is systemic comprehensive treatment. For patients with isolated single liver metastases and good respon

关 键 词：乳腺癌 肝脏转移 治疗 预后 

分 类 号：R737.9[医药卫生—肿瘤]