Department of Radiation Oncology, Changhua Christian Hospital, 135, Nan Shiau Street, Changhua, Taiwan, 500, Republic of China.
Support Care Cancer. 2010 Dec;18(12):1553-64. doi: 10.1007/s00520-009-0778-0. Epub 2009 Nov 11.
The purpose of this study is to analyze the survival rate of patients with metastatic breast cancer and to evaluate the outcome of these patients using prognostic factors and Nottingham prognostic index.
From February 1992 to August 2008, 135 patients with metastatic breast cancer were treated at the Changhua Christian Hospital. In these patients, we evaluated the significance of the following factors in predicting the survival rate after the occurrence of metastasis: age, initial stage at primary diagnosis, histological grade, Karnofsky performance status (KPS), estrogen receptor (ER), progesterone receptor status, human epidermoid growth factor receptor 2 overexpression status, number of axillary lymph node metastasis, history of adjuvant radiotherapy and/or chemotherapy, disease-free interval, status of local recurrence, status of various sites of distant metastases, number of distant metastases, and Nottingham prognostic index.
The 1-, 2-, and 5-year survival rates were 53.3%, 25.2%, and 1.5%, respectively. In the univariate analysis, KPS, histological grade, ER status, initial stage at primary diagnosis, number of axillary lymph node metastasis, liver metastasis, disease-free interval, first-/second-/third-line chemotherapy for recurrence or metastasis, number of metastases, and Nottingham prognostic index had significant impact on survival. The median survival of patients determined as corresponding to Nottingham low-risk group, intermediate-risk group, and high-risk group was 29.3, 17.9, and 4.6 months, respectively. In our multivariate analysis, Karnofsky performance status (p = 0.030) and Nottingham prognostic index (p ≤ 0.0001) were significant prognostic factors for survival, while first-/second-/third-line chemotherapy for recurrence or metastasis (p = 0.002) was a significant predictor for the outcome of the treatment.
The prognosis of patients with metastatic breast cancer is poor. In spite of the fact that many advances in treatment have been made, numerous additional questions have arisen; new drugs and therapeutic regimens are needed to improve the outcomes of patients, and further well-designed randomized trials are warranted.
本研究旨在分析转移性乳腺癌患者的生存率，并使用预后因素和诺丁汉预后指数评估这些患者的治疗效果。
1992 年 2 月至 2008 年 8 月，我们在彰化基督教医院共治疗了 135 例转移性乳腺癌患者。在这些患者中，我们评估了以下因素对转移后生存率的预测意义：年龄、初诊时的初始分期、组织学分级、卡氏功能状态（KPS）评分、雌激素受体（ER）状态、孕激素受体状态、人表皮生长因子受体 2 过表达状态、腋窝淋巴结转移数目、辅助放化疗史、无病间期、局部复发情况、远处转移各部位情况、远处转移数目、以及诺丁汉预后指数。
1、2、5 年生存率分别为 53.3%、25.2%和 1.5%。单因素分析结果显示，KPS 评分、组织学分级、ER 状态、初诊时的初始分期、腋窝淋巴结转移数目、肝转移、无病间期、复发或转移后的一线/二线/三线化疗、转移数目以及诺丁汉预后指数对生存情况有显著影响。诺丁汉低危组、中危组和高危组患者的中位生存时间分别为 29.3、17.9 和 4.6 个月。多因素分析结果显示，KPS 评分（p = 0.030）和诺丁汉预后指数（p ≤ 0.0001）是生存的显著预后因素，而复发或转移后的一线/二线/三线化疗（p = 0.002）是治疗效果的显著预测因素。
转移性乳腺癌患者的预后较差。尽管治疗方面取得了许多进展，但仍存在许多问题，需要新的药物和治疗方案来改善患者的预后，需要进一步进行精心设计的随机试验。
