Coleman R E, Rubens R D
Br J Cancer. 1987 Jan;55(1):61-6. doi: 10.1038/bjc.1987.13.
All patients with carcinoma of the breast seen in this Unit since 1970 were reviewed to study the incidence, prognosis, morbidity and response to treatment of bone metastases. The biological characteristics of the primary tumour were compared in patients relapsing first in bone or liver. Sixty-nine percent of patients dying with breast cancer had bone metastases and bone was the commonest site of first distant relapse. Bone relapse was more common in receptor positive or well differentiated (grade 1) tumours. The median survival was 24 months in those with disease apparently confined to the skeleton compared with 3 months after first relapse in liver. Ten percent of patients with breast cancer developed hypercalcaemia. All had metastatic disease and 85% had widespread skeletal involvement. Fifteen percent of patients with disease confined to the skeleton developed hypercalcaemia. The response in bone to primary endocrine therapy, and chemotherapy, was apparently less than the overall response achieved. A large proportion had apparently static disease reflecting the insensitivity of the UICC assessment criteria. The duration of survival in these patients was similar to responding patients, suggesting a tumour response may occur in the absence of discernable radiological evidence of healing.
对本单位自1970年以来收治的所有乳腺癌患者进行了回顾性研究，以探讨骨转移的发生率、预后、发病率及对治疗的反应。比较了首次在骨或肝复发患者的原发肿瘤生物学特性。69%死于乳腺癌的患者有骨转移，骨是远处首次复发最常见的部位。骨复发在受体阳性或高分化（1级）肿瘤中更常见。局限于骨骼的患者中位生存期为24个月，而首次肝复发后为3个月。10%的乳腺癌患者发生高钙血症。所有患者均有转移性疾病，85%有广泛的骨骼受累。局限于骨骼的患者中有15%发生高钙血症。骨对原发内分泌治疗和化疗的反应明显低于总体反应。很大一部分患者病情明显静止，这反映了国际抗癌联盟（UICC）评估标准的不敏感性。这些患者的生存期与有反应的患者相似，提示在没有可识别的影像学愈合证据的情况下可能发生肿瘤反应。
