乳腺癌首发单纯骨转移患者临床特征及预后分析  

Clinical characteristics and prognostic analysis of breast cancer patients with bone-only metastases

作　　者：迪丽胡玛尔·马木提 艾秀清[1] DILIHUMAER·Mamuti;AI Xiuqing(Department of Breast Radiotherapy,Cancer Hospital Affiliated to Xinjiang Medical University,Urumqi,Xinjiang 830011,China)

机构地区：[1]新疆医科大学附属肿瘤医院乳腺放射治疗科,新疆乌鲁木齐830011

出　　处：《中华肿瘤防治杂志》2023年第21期1308-1314,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：新疆维吾尔自治区自然科学基金(2016D01C346)。

摘　　要：目的分析乳腺癌首发单纯骨转移患者预后情况及可能的影响因素,并探讨乳腺癌早期骨转移的危险因素。方法回顾性分析2012-01-01-2017-12-31于新疆医科大学附属肿瘤医院收治的符合纳排标准的71例乳腺癌首发单纯骨转移患者临床资料,收集并整理其临床病理资料及随访数据。采用χ^(2)检验、Kaplan-Meier生存曲线及log-rank检验分析不同临床病理特征与患者早期骨转移风险和骨转移后总生存期(OS)的关联,并进一步行Cox比例风险回归分析确定独立影响因素。结果71例乳腺癌骨转移患者中位无骨转移时间(BFT)及中位OS均为22个月。单因素分析结果显示,确诊乳腺癌年龄(χ^(2)=7.663,P=0.006)、月经状态(χ^(2)=4.419,P=0.036)、N分期(χ^(2)=4.766,P=0.029)、人表皮生长因子受体2(HER2;χ^(2)=4.931,P=0.026)、Ki-67水平(χ^(2)=21.359,P<0.001)和分子分型(χ^(2)=20.157,P<0.001)为乳腺癌早期骨转移的危险因素。Cox比例风险模型分析结果显示,初诊乳腺癌年龄<40岁(HR=3.735,95%CI:1.539~9.065,P=0.004)、Ki-67高表达(HR=25.950,95%CI:3.334~201.994,P=0.002)和N分期(HR=0.257,95%CI:0.089~0.740,P=0.012)为乳腺癌早期骨转移的独立危险因素。Log-rank检验结果显示,初诊年龄>60岁(P=0.017)、骨转移后进展(P=0.037)、脉管癌栓(P=0.017)和BFT(P=0.033)与乳腺癌骨转移患者预后有统计学关联。多因素分析结果显示,初诊年龄>60岁(HR=2.670,95%CI:1.355~5.264,P=0.005)和脉管癌栓(HR=4.250,95%CI:1.347~13.409,P=0.014)是影响乳腺癌骨转移OS的独立危险因素。结论高龄及可见脉管癌栓的乳腺癌患者出现骨转移后OS更短。初诊年龄<40岁、Ki-67高表达及有淋巴结转移的乳腺癌患者更易发生早期骨转移。Objective To analyze the prognosis and possible influencing factors of breast cancer patients with primary simple bone metastasis,and to explore the risk factors of early bone metastasis of breast cancer.Methods Totally 71 cases of breast cancer patients with simple bone metastasis who met the inclusion and exclusion criteria from January 2012 to December 312017 were retrospectively analyzed in the Cancer Hospital affiliated to Xinjiang Medical University.We collected and organized clinical pathological data and follow-up data.Theχ^(2)test,Kaplan Meier survival curve,and log rank test were used to analyze the association between different clinical pathological features and the risk of early bone metastasis and overall survival(OS)after bone metastasis in patients.Further Cox proportional risk regression analysis was performed to determine independent influencing factors.Results The median bone metastasis free time(BFT)and median OS of 71 patients with bone metastases from breast cancer were 22 months.Univariate analysis showed that the age of diagnosis of breast cancer(χ^(2)=7.663,P=0.006),menstrual status(χ^(2)=4.419,P=0.036),N stage(χ^(2)=4.766,P=0.029),human epidermal growth factor receptor 2(HER2,χ^(2)=4.931,P=0.026),Ki-67 level(χ^(2)=21.359,P<0.001)and molecular typing(x^(2)=20.157,P<0.001)were risk factors for early bone metastasis of breast cancer.Cox proportional hazards model analysis showed that the age of breast cancer at first diagnosis<40 years old(HR=3.735,95%CI:1.539-9.065,P=0.004),Ki-67high expression(HR=25.950,95%CI:3.334-201.994,P=0.002)andN stage(HR=0.257,95%CI:0.089-0.740,P=0.012)were independent risk factors for early bone metastasis of breast cancer.The results of log rank test showed that the age of initial diagnosis 60years old(P=0.017),disease progression after bone metastasis(P=0.037),vascular tumor thrombus(P=0.017)and BFT(P=0.033)were statistically correlated with the prognosis of patients with bone metastasis of breast cancer.Multivariate analysis showed that the age of first di

关 键 词：乳腺癌 骨转移 风险因素 无骨转移时间 预后 

分 类 号：R737.9[医药卫生—肿瘤]