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乳腺癌肝转移的治疗:结果与预后因素

Treatment for liver metastases from breast cancer: results and prognostic factors.

作者信息

Li Xiao-Ping, Meng Zhi-Qiang, Guo Wei-Jian, Li Jie

机构信息

Department of Oncology, Xinhua Hospital, Shanghai Second Medical University, Shanghai 200090, China.

出版信息

World J Gastroenterol. 2005 Jun 28;11(24):3782-7. doi: 10.3748/wjg.v11.i24.3782.

Abstract

AIM

Liver metastases from breast cancer (BCLM) are associated with poor prognosis. Cytotoxic chemotherapy can result in regression of tumor lesions and a decrease in symptoms. Available data, in the literature, also suggest a subgroup of patients may benefit from surgery, but few talked about transcatheter arterial chemoembolization (TACE). We report the results of TACE and systemic chemotherapy for patients with liver metastases from breast cancer and evaluate the prognostic factors.

METHODS

Forty-eight patients with liver metastases, from proved breast primary cancer were treated with TACE or systemic chemotherapy between January 1995 and December 2000. Treatment results were assessed according to WHO criteria, along with analysis of prognostic factors for survival using Cox regression model.

RESULTS

The median follow-up was 28 mo (1-72 mo). Response rates were calculated for the TACE group and chemotherapy group, being 35.7% and 7.1%, respectively. The difference was significant. The one-, two- and three-year Survival rates for the TACE group were 63.04%, 30.35%, and 13.01%, and those for the systemic chemotherapy group were 33.88%, 11.29%, and 0%. According to univariate analysis, variables significantly associated with survival were the lymph node status of the primary cancer, the clinical stage of liver metastases, the Child-Pugh grade, loss of weight. Other factors such as age, the intervals between the primary to the metastases, the maximal diameter of the liver metastases, the number of liver metastases, extrahepatic metastasis showed no prognostic significances. These factors mentioned above such as the lymph node status of the primary cancer, the clinical stage of liver metastases, the Child-Pugh grade, loss of weight were also independent factors in multivariate analysis.

CONCLUSION

TACE treatment of liver metastases from breast cancer may prolong survival in certain patients. This approach offers new promise for the curative treatment of the patients with metastatic breast cancer.

摘要

目的

乳腺癌肝转移(BCLM)与预后不良相关。细胞毒性化疗可导致肿瘤病灶消退和症状减轻。文献中的现有数据还表明,一部分患者可能从手术中获益,但很少有人提及经导管动脉化疗栓塞术(TACE)。我们报告了TACE和全身化疗治疗乳腺癌肝转移患者的结果,并评估了预后因素。

方法

1995年1月至2000年12月期间,48例经证实为乳腺原发性癌肝转移的患者接受了TACE或全身化疗。根据WHO标准评估治疗结果,并使用Cox回归模型分析生存预后因素。

结果

中位随访时间为28个月(1 - 72个月)。计算了TACE组和化疗组的缓解率,分别为35.7%和7.1%。差异具有显著性。TACE组的1年、2年和3年生存率分别为63.04%、30.35%和13.01%,全身化疗组的生存率分别为33.88%、11.29%和0%。单因素分析显示,与生存显著相关的变量是原发性癌的淋巴结状态、肝转移的临床分期、Child-Pugh分级、体重减轻。其他因素如年龄、原发性癌至转移灶的间隔时间、肝转移灶的最大直径、肝转移灶数量、肝外转移均无预后意义。上述原发性癌的淋巴结状态、肝转移的临床分期、Child-Pugh分级、体重减轻等因素在多因素分析中也是独立因素。

结论

TACE治疗乳腺癌肝转移可能延长部分患者的生存期。这种方法为转移性乳腺癌患者的治愈性治疗带来了新的希望。

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