首发单纯骨转移乳腺癌患者的临床病理特征及预后分析
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摘要
目的:探讨乳腺癌首发单纯骨转移(bone-only metastasis,BOM)患者的临床病理学特征及预后特点。方法:回顾性分析2009年1月至2016年12月967例于天津医科大学肿瘤医院治疗的转移性乳腺癌患者的临床病理资料。分为180例BOM组与787例非BOM组,对BOM组患者的预后因素行单因素分析和Cox回归模型多因素分析,并根据激素受体(hormone receptor,HR)状态、转移数目及治疗方式行亚组分析。结果:BOM组与非BOM组患者的中位无进展生存(progression-free survival,PFS)时间分别为19.4个月与10.0个月,BOM组中位总生存(overall survival,OS)时间为45.6个月。BOM组与非BOM组HR阳性患者分别占81.7%(147/180)与64.7%(509/787)(P<0.001)。Cox回归模型多因素分析显示HR状态、转移位置、转移数目和治疗方式是BOM患者预后的独立影响因素。BOM组的HR阳性患者内分泌治疗(P=0.004)或联合治疗(P<0.001)较单独化疗的预后更佳。影响BOM组HR阳性患者预后的主要因素为骨转移数目和内分泌治疗。单部位骨转移患者行内分泌治疗(P=0.004)或联合治疗(P=0.002)较单独化疗的预后更佳,多部位骨转移患者行联合治疗较单独化疗(P<0.001)或内分泌治疗(P=0.04)的预后更佳。结论:对于HR阳性BOM尤其是单部位骨转移患者,单纯内分泌治疗可获得较为满意的疗效,而对于多部位BOM则应考虑行联合治疗。
Objective: To investigate the clinicopathological characteristics and prognostic factors in breast carcinoma patients with bone-only metastasis(BOM). Methods: A total of 967 patients with metastatic breast cancer treated in Tianjin Medical University Institute and Hospital between January 2009 and December 2016 were screened, and the case data were retrospectively analyzed. These data involve 180 cases in the BOM group and 787 cases in the non-BOM group. We performed univariate analysis and Cox regression model multivariate analysis of prognostic factors in patients with BOM. Subgroup analysis was performed according to the hormone receptor(HR) status, number of bone metastases, and treatment approaches. Results: Patients in the BOM group had a median progression-free survival(PFS) of 19.4 months, and non-BOM patients had a median PFS of 10.0 months. Patients in the BOM group had a median overall survival(OS) of 45.6 months. The proportions of patients with HR positivity were 81.7%(147/180) in the BOM group and64.7%(509/787) in the non-BOM group(P<0.001). Cox regression model multivariate analyses found that HR status, location of bone metastases, number of bone metastases, and treatment approach were independent factors influencing the prognosis of patients with BOM. Among patients with HR-positive BOM, the prognosis of patients receiving endocrine therapy(P=0.004) or combinatory therapy(P<0.001) was significantly better than that of patients receiving chemotherapy alone. The number of bone metastases and endocrine therapy were independent prognostic factors in patients with HR-positive BOM. Patients with single bone metastases who received endocrine therapy(P=0.004) or combinatory therapy(P=0.002) had better prognosis than patients who received chemotherapy alone.Patients with multiple bone metastases who received combinatory therapy had better prognosis than patients who received endocrine therapy(P=0.04) or chemotherapy alone(P<0.001). Conclusions: For HR-positive BOM patients, especially those with single metastases, endocrine therapy can obtain satisfactory outcomes. For patients with multiple metastases, combinatory therapy can be considered.
Objective: To investigate the clinicopathological characteristics and prognostic factors in breast carcinoma patients with bone-only metastasis(BOM). Methods: A total of 967 patients with metastatic breast cancer treated in Tianjin Medical University Institute and Hospital between January 2009 and December 2016 were screened, and the case data were retrospectively analyzed. These data involve 180 cases in the BOM group and 787 cases in the non-BOM group. We performed univariate analysis and Cox regression model multivariate analysis of prognostic factors in patients with BOM. Subgroup analysis was performed according to the hormone receptor(HR) status, number of bone metastases, and treatment approaches. Results: Patients in the BOM group had a median progression-free survival(PFS) of 19.4 months, and non-BOM patients had a median PFS of 10.0 months. Patients in the BOM group had a median overall survival(OS) of 45.6 months. The proportions of patients with HR positivity were 81.7%(147/180) in the BOM group and64.7%(509/787) in the non-BOM group(P<0.001). Cox regression model multivariate analyses found that HR status, location of bone metastases, number of bone metastases, and treatment approach were independent factors influencing the prognosis of patients with BOM. Among patients with HR-positive BOM, the prognosis of patients receiving endocrine therapy(P=0.004) or combinatory therapy(P<0.001) was significantly better than that of patients receiving chemotherapy alone. The number of bone metastases and endocrine therapy were independent prognostic factors in patients with HR-positive BOM. Patients with single bone metastases who received endocrine therapy(P=0.004) or combinatory therapy(P=0.002) had better prognosis than patients who received chemotherapy alone.Patients with multiple bone metastases who received combinatory therapy had better prognosis than patients who received endocrine therapy(P=0.04) or chemotherapy alone(P<0.001). Conclusions: For HR-positive BOM patients, especially those with single metastases, endocrine therapy can obtain satisfactory outcomes. For patients with multiple metastases, combinatory therapy can be considered.
引文
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[9] Zhang H, Zhu W, Biskup E, et al. Incidence, risk factors and prognostic characteristics of bone metastases and skeletal-related events(SREs)in breast cancer patients:a systematic review of the real world data[J].J Bone Oncol, 2018, 11:38-50.
[10]王倩,孙冰,孟祥颖,等.乳腺癌单纯骨转移患者预后相关因素分析[J].中华肿瘤防治杂志,2018,25(5):353-358.
[11] Imkampe A, Bendall S, Bates T. The significance of the site of recurrence to subsequent breast cancer survival[J]. Eur J Surg Oncol, 2007, 33(4):420-423.
[12] Ahn SG, Lee HM, Cho SH, et al. Prognostic factors for patients with bone-only metastasis in breast cancer[J]. Yonsei Med J, 2013, 54(5):1168-1177.
[13] Lipton A. Should bisphosphonates be utilized in the adjuvant setting for breast cancer[J]? Breast Cancer Res Treat, 2010, 122(3):627-636.
[14] James JJ, Evans AJ, Pinder SE, et al. Bone metastases from breast carcinoma:histopathological-radiological correlations and prognostic features[J]. Br J Cancer, 2003, 89(4):660-665.
[15] Parkes A, Warneke CL, Clifton K, et al. Prognostic factors in patients with metastatic breast cancer with bone-only metastases[J]. Oncologist,2018, 23(11):1282-1288.
[16] Cardoso F, Costa A, Senkus E, et al. 3rd ESO-ESMO international consensus guidelines for advanced breast cancer(ABC 3)[J]. Ann Oncol,2017, 28(12):3111.
[2] Mulcrone PL, Campbell JP, Clément-Demange L, et al. Skeletal colonization by breast cancer cells is stimulated by an osteoblast andβ2ARdependent neo-angiogenic switch[J]. J Bone Miner Res, 2017, 32(7):1442-1454.
[3] O'Carrigan B, Wong MH, Willson ML, et al. Bisphosphonates and other bone agents for breast cancer[J]. Cochrane Database Syst Rev, 2017,10:CD003474.
[4] Niikura N, Liu J, Hayashi N, et al. Treatment outcome and prognostic factors for patients with bone-only metastases of breast cancer:a single-institution retrospective analysis[J]. Oncologist, 2011, 16(2):155-164.
[5] Parkes A, Clifton K, Al-Awadhi A, et al. Characterization of bone only metastasis patients with respect to tumor subtypes[J]. NPJ Breast Cancer, 2018, 4:2.
[6] Hammond ME, Hayes DF, Dowsett M, et al. American society of clinical oncology/college of American pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer[J]. J Clin Oncol, 2010, 28(16):2784-2795.
[7] Diessner J, Wischnewsky M, Stüber T, et al. Evaluation of clinical parameters influencing the development of bone metastasis in breast cancer[J]. BMC Cancer, 2016, 16:307.
[8] Molnár IA, Molnár Bá, Vízkeleti L, et al. Breast carcinoma subtypes show different patterns of metastatic behavior[J]. Virchows Arch,2017, 470(3):275-283.
[9] Zhang H, Zhu W, Biskup E, et al. Incidence, risk factors and prognostic characteristics of bone metastases and skeletal-related events(SREs)in breast cancer patients:a systematic review of the real world data[J].J Bone Oncol, 2018, 11:38-50.
[10]王倩,孙冰,孟祥颖,等.乳腺癌单纯骨转移患者预后相关因素分析[J].中华肿瘤防治杂志,2018,25(5):353-358.
[11] Imkampe A, Bendall S, Bates T. The significance of the site of recurrence to subsequent breast cancer survival[J]. Eur J Surg Oncol, 2007, 33(4):420-423.
[12] Ahn SG, Lee HM, Cho SH, et al. Prognostic factors for patients with bone-only metastasis in breast cancer[J]. Yonsei Med J, 2013, 54(5):1168-1177.
[13] Lipton A. Should bisphosphonates be utilized in the adjuvant setting for breast cancer[J]? Breast Cancer Res Treat, 2010, 122(3):627-636.
[14] James JJ, Evans AJ, Pinder SE, et al. Bone metastases from breast carcinoma:histopathological-radiological correlations and prognostic features[J]. Br J Cancer, 2003, 89(4):660-665.
[15] Parkes A, Warneke CL, Clifton K, et al. Prognostic factors in patients with metastatic breast cancer with bone-only metastases[J]. Oncologist,2018, 23(11):1282-1288.
[16] Cardoso F, Costa A, Senkus E, et al. 3rd ESO-ESMO international consensus guidelines for advanced breast cancer(ABC 3)[J]. Ann Oncol,2017, 28(12):3111.