乳腺癌术后骨转移的相关临床危险因素分析  

Clinical risk factors related to bone metastasis after breast cancer surgery

作　　者：尤鸿吉 李心歆 周丽明[1] 刘影[1] 方哲雯 冯静敏 李傲 武兆忠[1] You Hongji;Li Xinxin;Zhou Liming;Liu Ying;Fang Zhewen;Feng Jingmin;Li Ao;Wu Zhaozhong(Department of Nuclear Medicine,Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China)

机构地区：[1]广州医科大学附属第二医院核医学科,广东广州510260

出　　处：《广州医科大学学报》2022年第1期39-45,共7页Academic Journal of Guangzhou Medical University

基　　金：广东省省级科技计划项目(2014A020212318)。

摘　　要：目的:分析乳腺癌患者术后发生骨转移的相关临床危险因素。方法:回顾性地收集2019年3月~2020年12月期间在广州医科大学附属第二医院核医学科行全身骨及局部SPECT/CT显像的241例乳腺癌术后患者的病历资料。应用Cox回归模型推测影响乳腺癌术后骨转移的因素,利用Kaplan-Meier法比较各危险因素下无骨转移时间差异并描绘骨转移时间曲线,并进行Log-rank检验。结果:在241例乳腺癌术后患者中,最终综合全身骨显像联合SPECT/CT显像及病理、随访结果、MR等资料诊断为骨转移者38例(15.8%,38/241),无骨转移者203例(84.2%,203/241)。COX单因素、多因素比例风险回归分析表明其中确诊年龄(HR=2.373,P=0.001)、T(肿瘤的大小分期)(HR=2.969,P=0.009)、术后有无内分泌治疗(HR=0.218,P=0.002)与CA153(HR=1.006,P=0.045)是影响乳腺癌患者术后发生骨转移的独立危险因素。结论:确诊年龄越大、原发肿瘤越大,术后无内分泌治疗,CA153越高的患者在随访的过程中更容易发生骨转移。Objective:To investigate the clinical risk factors related to bone metastasis after breast cancer surgery.Methods.Medical charts of 241 post-surgical patients with breast cancer,who underwent whole-body bone and regional SPECT/CT imaging at Department of Nuclear Medicine,Second Affiliated Hospital of Guangzhou Medical University between March 2019 and December 2020,were retrieved.Cox regression model was used to speculate on the factors related to bone metastasis after breast cancer surgery.Kaplan-Meier method was used to compare the bone metastasis-free duration among the risk factors.Then,time curves of bone metastasis-free duration were generated and subjected to Log-rank test.Results.Of 241 post-surgical patients with breast cancer,38(15.8%,38/241)were diagnosed as having bone metastases by comprehensive use of whole-body bone scanning,regional SPECT/CT imaging,pathological findings,follow-ups,and MR data.There were 203 patients without bone metastases(84.2%,203/241).Univariate and multivariate COX proportional hazard regression analysis showed that the age at diagnosis(HR=2.373,P=0.001),T(tumor size and staging)(HR=2.969,P=0.009),postoperative endocrinal therapy(HR=0.218,P=0.002)and CA153(HR=1.006,P=0.045)were independent risk factors for postoperative bone metastasis in breast cancer patients.Conclusion.Patients with elder age at diagnosis,larger primary lesion,no endocrinal therapy after surgery,and higher CA153 level are more likely to develop bone metastasis during the follow-up.

关 键 词：乳腺癌术后 骨转移 危险因素 SPECT/CT 

分 类 号：R737.9[医药卫生—肿瘤]