Chen H H W, Su W-C, Guo H-R, Lee B-F, Su W R, Wu P-S, Chiu N-T
Department of Radiation Oncology, National Cheng Kung University Hospital, Tainan, Taiwan.
Nucl Med Commun. 2003 Nov;24(11):1167-74. doi: 10.1097/00006231-200311000-00007.
The presence of one or two rib lesions on bone scans of post-treatment breast cancer patients without known metastases often makes clinical decision making problematic. The aim of this study was to identify skeletal metastasis predictors that might help the management of these patients. We recruited post-treatment breast cancer patients without overt metastases whose bone scans showed (1) one or two rib hot spots, or (2) one rib lesion and a concurrent bone abnormality. Their clinical and serial scintigraphic data were collected, reviewed and evaluated for correlations. After their first abnormal bone scans, 23 patients (11 of the 77 patients initially with one rib lesion (incidence, 14.3%), three of the 27 patients with two rib lesions (incidence, 11.1%), and nine of the 11 patients with one rib lesion plus a concurrent bone abnormality (incidence, 81.8%)) developed multiple bone metastases within 2 years of the initial rib lesions in all but one case. Univariate analyses revealed that a concurrent bone lesion other than the rib, direct tumour invasion to the chest wall or skin, and 10 or more lymph nodes involved were associated with increased risks of bone metastases whereas longer persistence of the rib lesions was associated with a lower risk. Multivariate proportional hazard analyses indicated that patients with a concurrent bone lesion other than the rib (relative risk (RR)=39.65; 95% confidence interval (CI)=8.13-193.28), 10 or more lymph nodes involved (RR=13.49; 95% CI=2.09-86.91), and no radiotherapy (RR=7.59; 95% CI=2.11-27.39) were more likely to have bone metastases, while those with longer persistence of the rib lesions (RR=0.92; 95% CI=0.84-0.98) and longer time interval between surgery and the rib lesion detection (RR=0.96; 95% CI=0.94-0.99) were less likely. We have identified clinical features applicable to risk stratification. High incidence of bone metastases was noted in patients with one rib lesion and a concurrent bone abnormality. Regular follow-up for 2 years after detection of rib lesions is recommended, especially for those with risk factors.
在无已知转移的乳腺癌术后患者的骨扫描中出现一两个肋骨病灶，常常会使临床决策变得困难。本研究的目的是确定可能有助于这些患者管理的骨转移预测因素。我们招募了无明显转移且骨扫描显示（1）一两个肋骨热点，或（2）一个肋骨病灶并伴有一处并发骨异常的乳腺癌术后患者。收集他们的临床和系列骨闪烁显像数据，进行回顾并评估相关性。在首次骨扫描异常后，23例患者（最初有一个肋骨病灶的77例患者中的11例（发生率为14.3%），有两个肋骨病灶的27例患者中的3例（发生率为11.1%），以及有一个肋骨病灶并伴有一处并发骨异常的11例患者中的9例（发生率为81.8%））在最初肋骨病灶出现后的2年内除1例之外均发生了多处骨转移。单因素分析显示，除肋骨外的并发骨病灶、肿瘤直接侵犯胸壁或皮肤以及累及10个或更多淋巴结与骨转移风险增加相关，而肋骨病灶持续时间较长与较低风险相关。多因素比例风险分析表明，除肋骨外有并发骨病灶的患者（相对风险（RR）=39.65；95%置信区间（CI）=8.13 - 193.28）、累及10个或更多淋巴结的患者（RR = 13.49；95% CI = 2.09 - 86.91）以及未接受放疗的患者（RR = 7.59；95% CI = 2.11 - 27.39）更有可能发生骨转移，而肋骨病灶持续时间较长的患者（RR = 0.92；95% CI = 0.84 - 0.98）以及手术与肋骨病灶检测之间时间间隔较长的患者（RR = 0.96；95% CI = 0.94 - 0.99）发生骨转移的可能性较小。我们已经确定了适用于风险分层的临床特征。在有一个肋骨病灶并伴有一处并发骨异常的患者中骨转移发生率较高。建议在发现肋骨病灶后进行2年的定期随访，尤其是对于那些有风险因素的患者。
