摘要
目的:研究与乳腺癌骨转移有关的临床、病理因素,探讨有助于预测乳腺癌骨转移的危险因素。方法:对本院1981年1月～2000年12月手术的3 796例乳腺癌患者的随访资料进行回顾分析,根据首发转移部位分组,研究116例骨转移的临床、病理资料,并与内脏转移、淋巴结或软组织转移患者的情况作比较。结果:本组病例首次复发为骨转移者116例,占3.1％;骨转移与患者年龄轻、肿块直径大、临床体检腋淋巴结肿大、腋淋巴结转移数多、病期为Ⅱ/Ⅲ期、组织学类型为非特殊型浸润性癌相关;多因素逐步回归分析术前资料显示,肿块大小、体检腋淋巴结状况与骨转移相关;术后资料中,肿块大小、腋淋巴结转移数、病理类型与骨转移相关。本组骨转移患者均曾接受正规的局部治疗和辅助化疗;首次复发在局部、淋巴结、软组织或局部复发伴远处转移组中,特殊型浸润性癌所占比例明显高于骨转移的患者;骨转移和内脏转移的时间分布无差别,而局部复发和/或淋巴结、软组织转移组,复发时间较骨转移组早。结论:年轻的、肿块分级为T2/T3,临床体检腋淋巴结肿大者,术前有必要进行同位素骨扫描检查;非特殊型浸润性乳腺癌,肿块分级为T2/T3,腋淋巴结转移数≥4枚,为骨转移的高危因素,可在此类病例中开展双磷酸盐的辅助治疗研究。
Purpose: To analyze the clinical and pathological factors in post-operative breast cancer patients with bone metastasis, and, identify risk factors predicting the skeletal metastasis. Methods: We evaluated data from 3 796 patients who were surgically treated from January 1981 to December 2000. Those patients were divided into groups according to different first events. Then we assessed data of 116 cases of bone metastasis as first event, and comparing with visceral metastasis and lymph node or soft tissue metastasis cases. Results: In our group there were 116 cases with bone metastasis as first event, about 3. 1%; bone metastasis correlated with young age, large tumor, clinical palpable axillary nodes, pathological positive nodes, stage II/HI disease and non-specific invasvie breast carcinoma. Multivariate logistic regression found that large tumor, clinical palpable axillary nodes related with bone metastasis in pre-operative data. In post-operative data, large tumor, pathological positive nodes and non-specific invasive breast carcinoma correlated with bone metastasis. Hormone receptor status and HER2 expression did not predict the bone metastasis. All cases received standard local and adjuvant systemic treatment. Among patients who had as their first event a local recurrence or a recurrence in soft tissue or lymph node or local and systemic metastasis, there were more specific invasive carcinomas than those in bone metastasis group. Occurrence of bone metastasis and visceral metastasis had similar time distribution, however, local recurrence and/or node, soft tissue metastasis occurred earlier than skeletal metastasis. Conclusions: Pre-operative bone scintigraphy was indicated in those with young age, T2/T3 tumor, and clinical palpable nodes. Breast cancer patients at high risk for bone metastasis were T2/T3 tumor, non-specific invasive breast carcinoma and with 4 or more involved axillary lymph nodes. It might be important to study the effect of bisphosphonates in the adjuvant settings.
出处
《中国癌症杂志》
CAS
CSCD
2003年第4期316-318,325,共4页
China Oncology
关键词
乳腺癌
骨转移
病理因素
研究
危险因素
breast neoplasms
bone metastasis
pathology
multivariate logistric regression
