新发 IV 期三阴性乳腺癌中特定部位转移和手术的预后价值：基于人群的分析。

BACKGROUND This retrospective study aimed to evaluate the prognostic roles of distant metastatic patterns in de novo metastatic triple-negative breast cancer to explore the roles of surgery on the primary tumor and to characterize the prognostic factors of organ-specific metastasis. MATERIAL AND METHODS Data were obtained from the Surveillance, Epidemiology, and End Results program. Kaplan-Meier analyses and log-rank tests were employed to compare survival outcomes among variables. The Cox proportional hazards model was used to assess risk factors for survival. The key endpoints were overall survival and breast cancer-specific survival. RESULTS A total of 1888 patients were eligible. Distant metastatic site displayed a significant prognostic impact on survival. Using liver metastasis as the reference, overall survival was higher for bone (hazard ratio [HR] 0.770, 95% confidence interval [CI] 0.634-0.935, P=0.008) and lung (HR 0.747, 95% CI 0.612-0.911, P=0.004) metastases. Using patients with brain metastasis as the reference, patients with bone (HR 0.516, 95% CI 0.392-0.680, P<0.001), lung (HR 0.500, 95% CI 0.379-0.661, P<0.001) or liver (HR 0.670, 95% CI 0.496-0.905, P=0.009) metastases exhibited better overall survival. Single-site metastatic patients who received surgery for the primary tumor had more favorable overall survival (P<0.001) and breast cancer-specific survival (P<0.001) than those who did not. Additionally, age, insurance status, chemotherapy, and surgery affected overall survival for patients with isolated bone metastasis; chemotherapy, and surgery affected overall survival for patients with isolated lung metastasis; and insurance status, chemotherapy, and surgery affected overall survival for patients with isolated liver metastasis. CONCLUSIONS Our study verified the specific prognostic significance of distant metastatic site for metastatic triple-negative breast cancer at diagnosis. Surgery on the primary tumor significantly improved survival for patients with single distant metastasis. The identified prognostic factors contributed to evaluating the prognoses for distant metastatic triple-negative breast cancer patients.

背景：本回顾性研究旨在评估初诊转移性三阴性乳腺癌的远处转移模式的预后作用，以探讨手术对原发性肿瘤的作用，并描述器官特异性转移的预后因素。

材料与方法：数据来自监测、流行病学和最终结果（Surveillance, Epidemiology, and End Results，SEER）计划。采用 Kaplan-Meier 分析和对数秩检验比较变量之间的生存结果。Cox 比例风险模型用于评估生存的危险因素。主要终点是总生存和乳腺癌特异性生存。

结果：共纳入 1888 例患者。远处转移部位对生存具有显著的预后影响。以肝转移为参照，骨转移（风险比[HR]0.770，95%置信区间[CI]0.634-0.935，P=0.008）和肺转移（HR 0.747，95%CI 0.612-0.911，P=0.004）的总生存更高。以脑转移患者为参照，骨转移（HR 0.516，95%CI 0.392-0.680，P<0.001）、肺转移（HR 0.500，95%CI 0.379-0.661，P<0.001）或肝转移（HR 0.670，95%CI 0.496-0.905，P=0.009）的患者总生存更好。接受原发性肿瘤手术的单一部位转移患者的总生存（P<0.001）和乳腺癌特异性生存（P<0.001）优于未接受手术的患者。此外，年龄、保险状况、化疗和手术影响孤立性骨转移患者的总生存；化疗和手术影响孤立性肺转移患者的总生存；保险状况、化疗和手术影响孤立性肝转移患者的总生存。

结论：本研究验证了远处转移部位对初诊转移性三阴性乳腺癌的特定预后意义。原发性肿瘤手术显著改善了单一远处转移患者的生存。确定的预后因素有助于评估远处转移性三阴性乳腺癌患者的预后。