Leone B A, Romero A, Rabinovich M G, Vallejo C T, Bianco A, Perez J E, Machiavelli M, Rodriguez R, Alvarez L A
Hospital Provincial Neuquén, Argentina.
Am J Clin Oncol. 1988 Dec;11(6):618-22.
The medical records of 414 patients with metastatic breast carcinoma treated between 1978 and 1986 were reviewed and 44 women were identified as having stage IV disease when the primary breast lesion was detected. Of these 44 women, 25 had metastatic disease limited to the skeleton while 19 had extraosseous lesions only. The clinical features, response to therapy, and survival were analyzed and compared for both groups. The median survival of those patients with bone-only metastases was 52 months as compared with 13 months for those with extraskeletal lesions (p = 0.0025). The response rate to first-line systemic therapy was similar for both groups (47% for bone metastases and 44% for extraosseous metastases). The median duration of response was 14 months (range, 3-55 months) for patients with bone disease and 8 months (range, 4-43 months) for those with extraskeletal lesions. We conclude that patients with metastatic breast cancer confined to the skeleton at initial diagnosis tend to follow an indolent, chronic course with prolonged survival. Therefore the increase in response rate with aggressive chemotherapy should be balanced against its higher morbidity. Further studies are needed to confirm whether the better prognosis of these patients is determined by the anatomical confinement of the disease to the skeleton or merely reflects the influence of other prognostic factors.
回顾了1978年至1986年间接受治疗的414例转移性乳腺癌患者的病历，其中44名女性在原发性乳腺病变被发现时被确定为患有IV期疾病。在这44名女性中，25名患者的转移性疾病局限于骨骼，而19名患者仅有骨外病变。对两组患者的临床特征、治疗反应和生存率进行了分析和比较。仅发生骨转移的患者中位生存期为52个月，而骨外病变患者的中位生存期为13个月（p = 0.0025）。两组对一线全身治疗的反应率相似（骨转移患者为47%，骨外转移患者为44%）。骨转移患者的中位缓解持续时间为14个月（范围3 - 55个月），骨外病变患者为8个月（范围4 - 43个月）。我们得出结论，初诊时转移性乳腺癌局限于骨骼的患者往往病程进展缓慢、呈慢性，生存期延长。因此，积极化疗带来的缓解率提高应与其更高的发病率相权衡。需要进一步研究来证实这些患者较好的预后是由疾病在解剖学上局限于骨骼所决定，还是仅仅反映了其他预后因素的影响。
