30例乳腺癌肝转移患者的临床分析和治疗评估
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摘要
目的：乳腺癌是女性最常见的恶性肿瘤。乳腺癌肝转移是一项独立的预后不良因素。多学科综合治疗能达到缓解症状,延长生存时间的目的。本文主要研究乳腺癌肝转移患者的临床特征、治疗的疗效评估及预后相关因素。
方法：回顾性分析2008年1月至2011年1月浙江大学医学院附属第一医院肿瘤科收治的30例乳腺癌肝转移患者的临床特征、治疗过程、疗效评价及生存情况。
结果：本文对30例乳腺癌肝转移患者进行分析。所有患者均为女性,发病年龄35-65岁,中位年龄53岁。其中起病年龄、TNM分期、ER状态与无进展生存期具有明显相关性。肿瘤大小、淋巴结转移数目、是否绝经对无进展生存期有影响,但未达到统计学意义。对于乳腺癌肝转移患者药物治疗联合局部治疗,肝转移后生存时间长于药物治疗组(分别为28.5月和32.8月),1年生存率分别为73.5%和87.5%；药物治疗联合局部治疗组肝转移后生存时间有延长趋势。肝脏首发转移较其他部位首发转移预后差(复发转移后中位生存时间分别为29.2月和73.2月,P=0.044)。
结论：乳腺癌肝转移预后较差。全身治疗联合局部治疗是乳腺癌肝转移患者的一个有效治疗方式。
Objective:Breast cancer is one of the most common malignant cancers of women. The prognosis of breast cancer patients with liver metastasis is poor. How to improve treatment efficacy and prolong survival of these patients is a challenge in clinic. The study aim is to explore the clinical characteristics, therapeutic strategies and prognosis agents of breast cancer liver metastasis patients.
Methods:The tolal of 30 breast cancer patients with liver metastasis admitted to the Department of Medical Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University from Mar.2008 to Mar.2011 were studied. The data of patients were gathered, including clinical characteristics, pathological diagnosis, ER status, PR status, HER2 status, staging, adjuvant treatments,palliative treatments and survival agents.
Results:30 patients were admitted into the study. The Median age of patients was 53.4 years, range from 35 years to 65 years. Firstly, we analysis the clinical characteristics ofⅠ-Ⅲstage patients, found that the onset age, TNM stage,ER status has correlated with PFS. The size of tumor, number of lymph node metastasis, menopause status can also impact PFS, but not reached statistically significant. The drug treatment combined with local treatment group has a longer MSR than drug treatment group (28.5m vs 32.8m, respectively). The liver metastasis prior to local metastasis or other organs has a poor prognosis(the survival time after metastasis or local recurrence 29.2m vs 73.2m respectively.P=0.044)
Conclusions:Breast cancer patients with liver metastasis have a poor prognosis. The systemic treatment combined with local treatment is a Promising Strategy for the candidate patients, which may get a better survival.
方法：回顾性分析2008年1月至2011年1月浙江大学医学院附属第一医院肿瘤科收治的30例乳腺癌肝转移患者的临床特征、治疗过程、疗效评价及生存情况。
结果：本文对30例乳腺癌肝转移患者进行分析。所有患者均为女性,发病年龄35-65岁,中位年龄53岁。其中起病年龄、TNM分期、ER状态与无进展生存期具有明显相关性。肿瘤大小、淋巴结转移数目、是否绝经对无进展生存期有影响,但未达到统计学意义。对于乳腺癌肝转移患者药物治疗联合局部治疗,肝转移后生存时间长于药物治疗组(分别为28.5月和32.8月),1年生存率分别为73.5%和87.5%；药物治疗联合局部治疗组肝转移后生存时间有延长趋势。肝脏首发转移较其他部位首发转移预后差(复发转移后中位生存时间分别为29.2月和73.2月,P=0.044)。
结论：乳腺癌肝转移预后较差。全身治疗联合局部治疗是乳腺癌肝转移患者的一个有效治疗方式。
Objective:Breast cancer is one of the most common malignant cancers of women. The prognosis of breast cancer patients with liver metastasis is poor. How to improve treatment efficacy and prolong survival of these patients is a challenge in clinic. The study aim is to explore the clinical characteristics, therapeutic strategies and prognosis agents of breast cancer liver metastasis patients.
Methods:The tolal of 30 breast cancer patients with liver metastasis admitted to the Department of Medical Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University from Mar.2008 to Mar.2011 were studied. The data of patients were gathered, including clinical characteristics, pathological diagnosis, ER status, PR status, HER2 status, staging, adjuvant treatments,palliative treatments and survival agents.
Results:30 patients were admitted into the study. The Median age of patients was 53.4 years, range from 35 years to 65 years. Firstly, we analysis the clinical characteristics ofⅠ-Ⅲstage patients, found that the onset age, TNM stage,ER status has correlated with PFS. The size of tumor, number of lymph node metastasis, menopause status can also impact PFS, but not reached statistically significant. The drug treatment combined with local treatment group has a longer MSR than drug treatment group (28.5m vs 32.8m, respectively). The liver metastasis prior to local metastasis or other organs has a poor prognosis(the survival time after metastasis or local recurrence 29.2m vs 73.2m respectively.P=0.044)
Conclusions:Breast cancer patients with liver metastasis have a poor prognosis. The systemic treatment combined with local treatment is a Promising Strategy for the candidate patients, which may get a better survival.
引文
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[1]Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011,61(2):69-90.
[2]Hoe AL, Royle GT, Taylor I. Breast liver metastases--incidence, diagnosis and outcome. J R Soc Med.1991,84(12):714-6.
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[4]Liu MT; Huarig WT, Wang AY, et al. Prediction of outcome of patients with metastatic breast cancer:evaluation with prognostic factors and Nottingham prognostic index. Support Care Cancer.2010,18(12):1553-64.
[5]Sawaki M, Ito Y, Hashimoto D, et al. Paclitaxel administered weekly in patients with docetaxel-resistant metastatic breast cancer:a single-center study. Tumori. 2004,90(1):36-9.
[6]Alba E, Martin M, Ramos M, et al. Multicenter randomized trial comparing sequential with concomitant administration of doxorubicin and docetaxel as first-line treatment of metastatic breast cancer:a Spanish Breast Cancer Research Group (GEICAM-9903) phase Ⅲ study. J Clin Oncol.2004,22(13):2587-93.
[7]Bottomley A, Biganzoli L, Cufer T, et al. Randomized, controlled trial investigating short-term health-related quality of life with doxorubicin and paclitaxel versus doxorubicin and cyclophosphamide as first-line chemotherapy in patients with metastatic breast cancer:European Organization for Research and Treatment of Cancer Breast Cancer Group, Investigational Drug Branch for Breast Cancer and the New Drug Development Group Study. J Clin Oncol.2004,22 (13):2576-86.
[8]Bonneterre J, Tubiana-Hulin M, Catimel G. Paclitaxel, epirubicin and cyclophosphamide combination in first-line treatment of metastatic breast cancer: a dose escalation study. Oncology.2004,66(3):185-91.
[9]Biganzoli L, Coleman R, Minisini A, et al. A joined analysis of two European Organization for the Research and Treatment of Cancer (EORTC) studies to evaluate the role of pegylated liposomal doxorubicin (Caelyx) in the treatment of elderly patients with metastatic breast cancer. Crit Rev Oncol Hematol. 2007,61(1):84-9.
[10]Seidman AD, Berry D, Cirrincione C, et al. Randomized phase Ⅲ trial of weekly compared with every-3-weeks paclitaxel for metastatic breast cancer, with trastuzumab for all HER-2 overexpressors and random assignment to trastuzumab or not in HER-2 nonoverexpressors:final results of Cancer and Leukemia Group B protocol 9840. J Clin Oncol.2008,26(10):1642-9.
[11]Jones SE, Erban J, Overmoyer B, et al. Randomized phase Ⅲ study of docetaxel compared with paclitaxel in metastatic breast cancer. J Clin Oncol. 2005,23(24):5542-51.
[12]Gradishar WJ, Tjulandin S, Davidson N, et al. Phase Ⅲ trial of nanoparticle albumin-bound paclitaxel compared with polyethylated castor oil-based paclitaxel in women with breast cancer. J Clin Oncol.2005,23(31):7794-803.
[13]O'Shaughnessy J, Miles D, Vukelja S, et al. Superior survival with capecitabine plus docetaxel combination therapy in anthracycline-pretreated patients with advanced breast cancer:phase Ⅲ trial results. J Clin Oncol.2002,20(12):2812-23.
[14]Albain KS, Nag SM, Calderillo-Ruiz G, et al. Gemcitabine plus Paclitaxel versus Paclitaxel monotherapy in patients with metastatic breast cancer and prior anthracycline treatment. J Clin Oncol.2008,26(24):3950-7.
[15]Seidman AD, Brufsky A, Ansari RH, et al. Phase Ⅲ trial of gemcitabine plus docetaxel versus capecitabine plus docetaxel with planned crossover to the alternate single agent in metastatic breast cancer. Ann Oncol.2010.
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[17]Martin M, Ruiz A, Munoz M, et al. Gemcitabine plus vinorelbine versus vinorelbine monotherapy in patients with metastatic breast cancer previously treated with anthracyclines and taxanes:final results of the phase Ⅲ Spanish Breast Cancer Research Group (GEICAM) trial. Lancet Oncol.2007,8(3):219-25.
[18]Stemmler HJ, Digioia D, Freier W, et al. Randomised phase Ⅱ trial of gemcitabine plus vinorelbine vs gemcitabine plus cisplatin vs gemcitabine plus capecitabine in patients with pretreated metastatic breast cancer. Br J Cancer.2011,104(7):1071-8.
[19]Hess D, Koberle D, Thurlimann B, et al. Capecitabine and vinorelbine as first-line treatment in elderly patients (>or=65 years) with metastatic breast cancer. A phase Ⅱ trial (SAKK 25/99). Oncology.2007,73(3-4):228-37.
[20]Blum JL, Jones SE, Buzdar AU, et al. Multicenter phase Ⅱ study of capecitabine in paclitaxel-refractory metastatic breast cancer. J Clin Oncol.1999,17(2):485-93.
[21]Blum JL, Dieras V, Lo Russo PM, et al. Multicenter, Phase Ⅱ study of capecitabine in taxane-pretreated metastatic breast carcinoma patients. Cancer. 2001,92(7):1759-68.
[22]Fumoleau P, Largillier R, Clippe C, et al. Multicentre, phase Ⅱ study evaluating capecitabine monotherapy in patients with anthracycline- and taxane-pretreated metastatic breast cancer. Eur J Cancer.2004,40(4):536-42.
[23]Lee SH, Lee J, Park J, et al. Capecitabine monotherapy in patients with anthracycline- and taxane-pretreated metastatic breast cancer. Med Oncol. 2004,21 (3):223-31.
[24]Reichardt P, Von Minckwitz G, Thuss-Patience PC, et al. Multicenter phase Ⅱ study of oral capecitabine (Xeloda(")) in patients with metastatic breast cancer relapsing after treatment with a taxane-containing therapy. Ann Oncol.2003,14 (8):1227-33.
[25]Cameron D. Lapatinib plus capecitabine in patients with HER2-positive advanced breast cancer. Clin Adv Hematol Oncol.2007,5(6):456-8.
[26]Geyer CE, Forster J, Lindquist D, et al. Lapatinib plus capecitabine for HER2-positive advanced breast cancer. N Engl J Med.2006,355(26):2733-43.
[27]Wang J, Fan Y, Xu B. Ixabepilone plus capecitabine for Chinese patients with metastatic breast cancer progressing after anthracycline and taxane treatment. Cancer Chemother Pharmacol.2010,66(3):597-603.
[28]Reed SD, Li Y, Anstrom KJ, et al. Cost effectiveness of ixabepilone plus capecitabine for metastatic breast cancer progressing after anthracycline and taxane treatment. J Clin Oncol.2009,27(13):2185-91.
[29]Thomas ES. Ixabepilone plus capecitabine for metastatic breast cancer progressing after anthracycline and taxane treatment. J Clin Oncol.2008,26(13):2223.
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