Solomayer E F, Diel I J, Meyberg G C, Gollan C, Bastert G
Department of Obstetrics and Gynecology, University of Heidelberg, Germany.
Breast Cancer Res Treat. 2000 Feb;59(3):271-8. doi: 10.1023/a:1006308619659.
Although metastasis is a frequent event in breast cancer patients, insight into the clinical course, prognosis and therapy with respect to the site of the first metastases has been poor and contradictory in former investigations. Follow-up data from 648 patients with metastatic breast cancer were statistically analyzed. Patients with bone metastases at first relapse had better overall survival (median 71 vs. 48 months; p < 0.001) and survival after first metastases (median 24 vs 12 months; p < 0.001) than patients with visceral metastases at first relapse. Bone was the site of first metastasis in 46%, and 71% of patients with metastatic breast cancer developed bone metastases. The localization of the second metastatic site was of prognostic relevance in patients with first visceral metastases, but not in patients with first bone metastases. The presence of osseous metastases correlated significantly with estrogen and progesterone receptor positivity, tumor grading I/II and S-phase fraction <5%. The better prognosis of patients with bone metastases is not determined exclusively by hormone receptor status. The disease is significantly more stable in patients with first bone metastases than in those with first visceral metastases.
尽管转移在乳腺癌患者中很常见，但以往研究中对于首次转移部位的临床病程、预后及治疗的认识一直较为匮乏且相互矛盾。对648例转移性乳腺癌患者的随访数据进行了统计分析。首次复发时出现骨转移的患者较首次复发时出现内脏转移的患者具有更好的总生存期（中位生存期分别为71个月和48个月；p<0.001）以及首次转移后的生存期（中位生存期分别为24个月和12个月；p<0.001）。骨是46%的首次转移部位，71%的转移性乳腺癌患者发生了骨转移。对于首次出现内脏转移的患者，第二个转移部位的定位具有预后相关性，但对于首次出现骨转移的患者则不然。骨转移的存在与雌激素和孕激素受体阳性、肿瘤分级I/II以及S期分数<5%显著相关。骨转移患者较好的预后并非仅由激素受体状态决定。首次出现骨转移的患者病情明显比首次出现内脏转移的患者更稳定。
