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英国一家三级中心的乳腺癌肝转移:肿瘤委员会会议转诊后的结果。

Breast cancer liver metastases in a UK tertiary centre: Outcomes following referral to tumour board meeting.

机构信息

Institute of Liver Studies, King's College Hospital, London, UK.

Institute of Liver Studies, King's College Hospital, London, UK.

出版信息

Int J Surg. 2017 Aug;44:152-159. doi: 10.1016/j.ijsu.2017.06.049. Epub 2017 Jun 20.

Abstract

INTRODUCTION

To assess the outcomes from multidisciplinary board meetings (MDM) for patients with breast cancer liver metastases (BCLM) and identify prognostic factors for survival.

MATERIALS AND METHODS

A retrospective review of MDM records for patients referred with BCLM to a tertiary centre between 2005 and 2016. Patient demographics, clinicopathological factors and intervention type were analysed to find predictive factors for overall survival.

RESULTS

61 patients with BCLM were referred to the MDM. Treatment pathways included surgical resection (n = 23), radiofrequency ablation (RFA, n = 11), or chemotherapy (n = 27). Surgical resection patients had an improved median overall survival compared to chemotherapy (49 v 20mo; p < 0.001). RFA showed comparable survival benefit (37 v 20mo; p = 0.011). Resection and RFA showed no significant difference in survival over one another (49 v 37mo; p = 0.854). Survival analysis identified that resection (p = 0.002) and RFA (p = 0.001) were associated with improved overall survival compared to chemotherapy. Multivariate analysis identified extrahepatic disease (HR = 14.21; p = 0.044) and R0 resection (HR = 0.068; p = 0.023) as prognostic factors.

CONCLUSIONS

Surgical resection of BCLM may improve the overall survival in selected patient groups. This study identifies a cohort of patients, without extrahepatic disease and responsive to chemotherapy, who may particularly benefit from surgery.

摘要

简介

评估多学科委员会会议(MDM)对乳腺癌肝转移(BCLM)患者的治疗效果,并确定生存的预后因素。

材料和方法

回顾性分析了 2005 年至 2016 年间,在一家三级中心因 BCLM 就诊的患者的 MDM 记录。分析了患者的人口统计学、临床病理学因素和干预类型,以找到总生存的预测因素。

结果

61 例 BCLM 患者被转介到 MDM。治疗途径包括手术切除(n=23)、射频消融(RFA,n=11)或化疗(n=27)。与化疗相比,手术切除患者的中位总生存时间明显改善(49 与 20mo;p<0.001)。RFA 显示出类似的生存获益(37 与 20mo;p=0.011)。切除和 RFA 之间的生存差异无统计学意义(49 与 37mo;p=0.854)。生存分析发现,与化疗相比,切除(p=0.002)和 RFA(p=0.001)与改善的总生存相关。多变量分析确定肝外疾病(HR=14.21;p=0.044)和 R0 切除(HR=0.068;p=0.023)是预后因素。

结论

手术切除 BCLM 可能改善选定患者群体的总体生存率。本研究确定了一组无肝外疾病且对化疗有反应的患者,他们可能特别受益于手术。

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