Taal B G, Peterse H, Boot H
Department of Gastroenterology, Netherlands Cancer Institute/Antoni van Leeuwenhoekhuis, Amsterdam.
Cancer. 2000 Dec 1;89(11):2214-21.
Breast carcinoma is the most common malignancy in women. Metastatic involvement of the stomach is not well known.
Endoscopic features and treatment options were evaluated retrospectively for 51 patients with gastric metastases of breast carcinoma.
The presenting sites of metastases were skeleton (43%), stomach (27%), lung (8%), and liver (4%). Diagnosis of gastric involvement was histologically confirmed in 41 patients and based on endoscopic features, despite negative biopsies in 10 patients. Six patients (12%) presented with nonfatal hemorrhage; in the others, symptoms were nonspecific: anorexia (71%), epigastric pain (53%), and vomiting (41%). Endoscopy showed 3 patterns: 18% localized lesions, 57% diffuse infiltration, and 25% external compression at the cardia or pylorus. Histology showed mainly lobular breast carcinoma (n = 36) compared with ductal carcinoma (n = 10) and other types (n = 5), contrary to the usual distribution. The overall response to systemic therapy was 46% (17 of 37 treated patients). Median survival from detection of gastric metastases was 10 months, with a 2-year survival rate of 23%.
Gastric metastases usually derive from lobular rather than ductal breast carcinoma. Endoscopy revealed mainly a diffuse linitis plastica-like infiltration. Chemotherapy or hormonal treatment may result in fair palliation in selected patients, although many patients are heavily pretreated.
乳腺癌是女性最常见的恶性肿瘤。胃转移的情况尚不为人熟知。
对51例乳腺癌胃转移患者的内镜特征和治疗选择进行回顾性评估。
转移的常见部位为骨骼（43%）、胃（27%）、肺（8%）和肝脏（4%）。41例患者经组织学确诊胃受累，10例患者活检阴性但根据内镜特征确诊。6例患者（12%）出现非致命性出血；其他患者症状不具特异性：厌食（71%）、上腹部疼痛（53%）和呕吐（41%）。内镜检查显示3种模式：18%为局限性病变，57%为弥漫性浸润，25%为贲门或幽门处的外压性病变。组织学检查显示主要为小叶型乳腺癌（n = 36），而导管癌（n = 10）和其他类型（n = 5）较少，与通常的分布情况相反。全身治疗的总体缓解率为46%（37例接受治疗的患者中有17例）。从发现胃转移开始计算的中位生存期为10个月，2年生存率为23%。
胃转移通常源自小叶型而非导管型乳腺癌。内镜检查主要显示为弥漫性皮革胃样浸润。化疗或激素治疗可能会使部分患者获得一定程度的缓解，尽管许多患者此前已接受过大量治疗。
