乳腺癌骨转移危险因素的系统评价  

Risk factors for bone metastasis in breast cancer:A systematic review

作　　者：孙玉颖 陈佳佳 乔晓娟 王叶婷 徐雨 朱耀峰[1] 宋秋月 SUN Yu-ying(School of Medicine,Jishou University,Xiangxi Autonomous Prefecture 416000,Hunan,China)

机构地区：[1]吉首大学医学院,湖南湘西土家族苗族自治州416000 [2]湖南医药学院总医院,湖南怀化418000

出　　处：《牡丹江医科大学学报》2025年第1期96-104,共9页Journal of Mudanjiang Medical University

基　　金：国家自然科学基金项目(82260264);湖南省教育厅科学研究项目(23A0397);吉首大学研究生科研创新项目(JDY2024102)。

摘　　要：目的系统评价国内外乳腺癌患者骨转移的发生率与危险因素,为临床降低骨转移的发生率提供依据。方法通过计算机检索中英文数据库中国知网、维普、万方、中国生物医学文献数据库、Pubmed、Medline、Scopus、The Cochrane Library、Web of Science、Embase,搜索从建库至2024年4月17日发表的有关乳腺癌骨转移危险因素或影响因素的文献,按照纳入和排除标准筛选文献,使用Revman 5.4、Stata 17.0进行系统评价。结果本研究共纳入27篇文献,包括乳腺癌患者307993例,其中发生骨转移的患者12283例。Meta分析结果显示,纳入的研究结果间存在明显的统计学异质性(I^(2)=99.1%,P<0.001)。采用随机效应模型进行合并,骨转移发生率为27.8%[95%CI(0.232,0.324),P<0.001]。骨转移发生率的危险因素是年龄(≤40岁、≥50岁)、淋巴结阳性、伴内脏转移、临床分期晚(Ⅲ、Ⅳ期)、肿瘤直径≥5 cm、Ki-67高表达、肿瘤标记物(CEA、CA125)水平升高、生物标记物(nm23蛋白)低表达、ALP水平升高、低Hb、分子分型(luminal型、TNBC)。结论医护人员应对高危患者给予重点关注,尽早采取预防措施与治疗。Objective To systematically review the incidence and risk factors of bone metastasis in breast cancer patients domestically and internationally,providing basis for clinical prevention and reduction of the incidence of bone metastasis.Methods CNKI,VIP,Wanfang,Chinese Biomedical Literature Database,PubMed,Medline,Scopus,The Cochrane Library,Web of Science,Embase were searched for articles on risk factors or influencing factors of bone metastasis of breast cancer published from the establishment of the database to April 17,2024.The literature was screened according to the inclusion and exclusion criteria,and Revman5.4 and Stata17.0 were used for systematic review.Results A total of 27 articles were included in this study,including 307,993 breast cancer patients,of which 12,283 patients had bone metastases.Meta-analysis showed that there was significant statistical heterogeneity among the included studies(I^(2)=99.1%,P<0.001).Using the random effects model,the incidence of bone metastasis was 27.8%[95%CI(0.232,0.324),P<0.001].The risk factors of bone metastasis were age(≤40 years,≥50 years),lymph node positivity,visceral metastasis,late clinical stage(Ⅲ,Ⅳ),tumor diameter≥5cm,high expression of Ki-67,increased levels of tumor markers(CEA,CA125),low expression of biomarker(nm23 protein),increased ALP level,and low Hb level,Molecular typing(luminal,TNBC).Conclusion Medical staff should pay more attention to high-risk patients and take preventive measures and treatment as soon as possible.

关 键 词：乳腺癌 骨转移 危险因素 影响因素 系统评价 

分 类 号：R737.9[医药卫生—肿瘤]