乳腺癌肝脏转移患者的临床病理特征及预后因素分析
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摘要
目的探讨乳腺癌肝脏转移患者的临床病理特征及预后影响因素。方法选取146例女性乳腺癌肝转移患者为研究对象,其中62例手术治疗前发生肝转移者为术前肝转移组,84例手术治疗后发生肝转移者为术后肝转移组。分析两组患者的临床病理特征、生存时间及预后影响因素。结果两组乳腺癌患者的年龄、月经状态、病理类型比较,差异均无统计学意义(均P> 0. 05),而两组的临床肿瘤分期、分子亚型、淋巴结转移数目、肝脏多发性转移灶情况比较,差异均有统计学意义(均P <0. 05)。术后肝转移组患者术后5年的生存率和中位数生存时间高于或长于术前肝转移组患者(均P <0. 05)。多因素分析结果显示,年龄对术前乳腺癌肝转移患者和术后乳腺癌肝转移患者的预后均无影响(均P> 0. 05);临床肿瘤分期低、淋巴结转移数目少、肝脏多发性转移灶局限、放射治疗、靶向治疗均是术前乳腺癌肝转移患者和术后乳腺癌肝转移患者生存的保护因素(均P <0. 05),各分子亚型中,三阴性型乳腺癌肝转移患者死亡风险最大(P <0. 05)。结论乳腺癌发生肝脏转移后预后较差,原癌基因人类表皮生长因子受体2过表达型和三阴性型乳腺癌肝转移患者相对于Luminal型患者预后生存时间更短,临床肿瘤分期低、淋巴结转移数目少、肝脏多发性转移灶局限、放射治疗、靶向治疗是乳腺癌肝转移患者术后生存的保护因素。
Objective To investigate the clinicopathological features and prognostic factors in patients with liver metastases from breast cancer. Methods A total of 146 female patients with liver metastases from breast cancer were enrolled as the subjects. Among them,62 cases had liver metastases before operation were enrolled as preoperative liver metastasis group,and 84 cases had liver metastases after operation were enrolled as postoperative liver metastasis group. Clinicopathological characteristics,survival time,and factors influencing prognosis were analyzed in the two groups. Results There were no statistically significant differences in age,menstrual status,or pathological type between the two groups( all P > 0. 05),but statistically significant differences were found between the two groups in clinical TNM stage,molecular subtype,number of lymph node metastases,and multiple liver metastases condition( all P < 0. 05). The postoperative liver metastasis group had a higher postoperative 5-year survival rate and a longer median survival time than the preoperative liver metastasis group( all P < 0. 05). Multivariate analysis results showed that age had no effects on the prognosis of patients with preoperative or postoperative liver metastasis from breast cancer( all P > 0. 05); low clinical TNM stage,minor number of lymph node metastases,multiple metastases remaining localized in the liver,radiotherapy,and targeted therapy were protective factors for the survival of patients with preoperative or postoperative liver metastasis from breast cancer( all P <0. 05),among the molecular subtypes,patients with triple-negative liver metastases from breast cancer were at the highest risk of death( P < 0. 05). Conclusion The prognosis of breast cancer is poorer after developing liver metastasis,patients with proto-oncogene,overexpressed human epidermal growth factor receptor 2,and three-negative liver metastasis from breast cancer have a shorter prognostic survival time than patients of Luminal type,low clinical TNM stage,minor number of lymph node metastases,multiple metastases remaining localized in the liver,radiotherapy,and targeted therapy are protective factors for the postoperative survival of patients with liver metastasis from breast cancer.
Objective To investigate the clinicopathological features and prognostic factors in patients with liver metastases from breast cancer. Methods A total of 146 female patients with liver metastases from breast cancer were enrolled as the subjects. Among them,62 cases had liver metastases before operation were enrolled as preoperative liver metastasis group,and 84 cases had liver metastases after operation were enrolled as postoperative liver metastasis group. Clinicopathological characteristics,survival time,and factors influencing prognosis were analyzed in the two groups. Results There were no statistically significant differences in age,menstrual status,or pathological type between the two groups( all P > 0. 05),but statistically significant differences were found between the two groups in clinical TNM stage,molecular subtype,number of lymph node metastases,and multiple liver metastases condition( all P < 0. 05). The postoperative liver metastasis group had a higher postoperative 5-year survival rate and a longer median survival time than the preoperative liver metastasis group( all P < 0. 05). Multivariate analysis results showed that age had no effects on the prognosis of patients with preoperative or postoperative liver metastasis from breast cancer( all P > 0. 05); low clinical TNM stage,minor number of lymph node metastases,multiple metastases remaining localized in the liver,radiotherapy,and targeted therapy were protective factors for the survival of patients with preoperative or postoperative liver metastasis from breast cancer( all P <0. 05),among the molecular subtypes,patients with triple-negative liver metastases from breast cancer were at the highest risk of death( P < 0. 05). Conclusion The prognosis of breast cancer is poorer after developing liver metastasis,patients with proto-oncogene,overexpressed human epidermal growth factor receptor 2,and three-negative liver metastasis from breast cancer have a shorter prognostic survival time than patients of Luminal type,low clinical TNM stage,minor number of lymph node metastases,multiple metastases remaining localized in the liver,radiotherapy,and targeted therapy are protective factors for the postoperative survival of patients with liver metastasis from breast cancer.
引文
[1] Li T,Mello-Thoms C,Brennan PC. Descriptive epidemiology of breast cancer in China:incidence,mortality,survival and prevalence[J]. Breast Cancer Res Treat,2016,159(3):395-406.
[2] Zaidi Z,Cherif MH. The descriptive epidemiology of female breast cancer:an international comparison of incidence,survival and mortality[J]. Int J Epidemiol,2015,44(Suppl 1):i115.
[3] Hara T,Iwadate M,Tachibana K,et al. Metastasis of breast cancer cells to the bone,lung,and lymph nodes promotes resistance to ionizing radiation[J]. Strahlenther Onkol,2017,193(10):848-855.
[4]赵京阳,顾梅,党受涛,等.乳腺癌肝转移诊断及治疗的研究进展[J].中国医药,2015,10(11):1 720-1 722.
[5]李博,陈雪松.乳腺癌肝转移机制研究进展[J].实用肿瘤学杂志,2017,31(1):48-52.
[6] Edge SB,Compton CC. The American Joint Committee on Cancer:the 7th edition of the AJCC cancer staging manual and the future of TNM[J]. Ann Surg Oncol,2010,17(6):1 471-1 474.
[7] Goldhirsch A,Winer EP,Coates AS,et al. Personalizing the treatment of women with early breast cancer:highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013[J]. Ann Oncol,2013,24(9):2 206-2 223.
[8] Wolff AC,Hammond ME,Schwartz JN,et al. Guideline Summary:American Society of Clinical Oncology/College of American Pathologists guideline recommendation for human epidermal growth factor receptor HER2 testing in breast cancer[J]. J Clin Oncol,2007,3(1):48-50.
[9]陈鑫.老年不同分子分型乳腺癌的临床特点、预后及影响预后的相关因素[J].中国老年学杂志,2016,36(8):1 910-1 912.
[10]王峥,陈洪志,董济民,等.乳腺癌肝转移患者化疗后维持治疗的疗效及安全性研究[J].陕西医学杂志,2016,45(10):1 313-1 315.
[11]徐娟,赵晔.射频消融联合化学治疗在乳腺癌肝转移中临床效果[J].医学研究杂志,2017,46(1):59-62.
[12]李杰,徐向东,邵楠,等. 163例乳腺癌肝脏转移临床资料和预后因素分析[J].岭南现代临床外科,2016,16(5):574-579.
[13]白秀梅,杨薇,严昆.乳腺癌肝转移治疗现状及射频消融的应用及前景[J].世界华人消化杂志,2017,25(13):1 143-1 149.
[14]陈建彬,王蓓,高秀飞.激素受体阳性乳腺癌预后影响因素分析[J].浙江医学,2015,37(5):367-370.
[15]岳健,马飞,张灵小,等.激素受体阳性乳腺癌首发肝转移患者临床特征与预后分析[J].中华医学杂志,2014,94(4):260-264.
[16]易平,刘剑勇,张志明,等. Luminal型乳腺癌术后肝转移患者预后因素分析[J].中华肿瘤防治杂志,2016,23(24):1 619-1 622.
[17]赵灿,李心乐,王俊艳,等.三阴性乳腺癌肝肺转移治疗的研究进展[J].中国民康医学,2015,27(14):186.
[18] Phipps AI,Malone KE,Porter PL,et al. Reproductive and hormonal risk factors for postmenopausal luminal,HER-2-overexpressing,and triple-negative breast cancer[J]. Cancer,2008,113(7):1 521-1 526.
[2] Zaidi Z,Cherif MH. The descriptive epidemiology of female breast cancer:an international comparison of incidence,survival and mortality[J]. Int J Epidemiol,2015,44(Suppl 1):i115.
[3] Hara T,Iwadate M,Tachibana K,et al. Metastasis of breast cancer cells to the bone,lung,and lymph nodes promotes resistance to ionizing radiation[J]. Strahlenther Onkol,2017,193(10):848-855.
[4]赵京阳,顾梅,党受涛,等.乳腺癌肝转移诊断及治疗的研究进展[J].中国医药,2015,10(11):1 720-1 722.
[5]李博,陈雪松.乳腺癌肝转移机制研究进展[J].实用肿瘤学杂志,2017,31(1):48-52.
[6] Edge SB,Compton CC. The American Joint Committee on Cancer:the 7th edition of the AJCC cancer staging manual and the future of TNM[J]. Ann Surg Oncol,2010,17(6):1 471-1 474.
[7] Goldhirsch A,Winer EP,Coates AS,et al. Personalizing the treatment of women with early breast cancer:highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013[J]. Ann Oncol,2013,24(9):2 206-2 223.
[8] Wolff AC,Hammond ME,Schwartz JN,et al. Guideline Summary:American Society of Clinical Oncology/College of American Pathologists guideline recommendation for human epidermal growth factor receptor HER2 testing in breast cancer[J]. J Clin Oncol,2007,3(1):48-50.
[9]陈鑫.老年不同分子分型乳腺癌的临床特点、预后及影响预后的相关因素[J].中国老年学杂志,2016,36(8):1 910-1 912.
[10]王峥,陈洪志,董济民,等.乳腺癌肝转移患者化疗后维持治疗的疗效及安全性研究[J].陕西医学杂志,2016,45(10):1 313-1 315.
[11]徐娟,赵晔.射频消融联合化学治疗在乳腺癌肝转移中临床效果[J].医学研究杂志,2017,46(1):59-62.
[12]李杰,徐向东,邵楠,等. 163例乳腺癌肝脏转移临床资料和预后因素分析[J].岭南现代临床外科,2016,16(5):574-579.
[13]白秀梅,杨薇,严昆.乳腺癌肝转移治疗现状及射频消融的应用及前景[J].世界华人消化杂志,2017,25(13):1 143-1 149.
[14]陈建彬,王蓓,高秀飞.激素受体阳性乳腺癌预后影响因素分析[J].浙江医学,2015,37(5):367-370.
[15]岳健,马飞,张灵小,等.激素受体阳性乳腺癌首发肝转移患者临床特征与预后分析[J].中华医学杂志,2014,94(4):260-264.
[16]易平,刘剑勇,张志明,等. Luminal型乳腺癌术后肝转移患者预后因素分析[J].中华肿瘤防治杂志,2016,23(24):1 619-1 622.
[17]赵灿,李心乐,王俊艳,等.三阴性乳腺癌肝肺转移治疗的研究进展[J].中国民康医学,2015,27(14):186.
[18] Phipps AI,Malone KE,Porter PL,et al. Reproductive and hormonal risk factors for postmenopausal luminal,HER-2-overexpressing,and triple-negative breast cancer[J]. Cancer,2008,113(7):1 521-1 526.