乳腺癌肝转移的临床病程与预后分析

目的 探讨乳腺癌肝转移的临床病程、治疗效果及预后因素。方法 采用SPSS 11.5统计软件对152例乳腺癌肝转移患者的生存及预后因素进行回顾性分析。结果 全组中位无病生存期（DFS）为21个月,转移后中位生存期（MSR）为16个月,中位至疾病进展时间（TTP）为7．4个月。肝转移后一线化疗的有效率为54．5％,高于介入治疗（37．7％,P=0．039）。含紫杉类方案化疗组的有效率为63．3％,高于不含紫杉类方案化疗组（40．O％,P=0．04）;含紫杉类方案化疗组的TTP为10个月,亦高于不含紫杉类方案化疗组（7个月,P=0．048）。无论介入治疗（TACE）,还是化疗,治疗有效者的MSR（18个月）均长于无效者（14个月,P=0．002）。对于单发肝转移瘤患者,单纯介入治疗的MSR（30个月）长于单纯化疗（16个月,P=0．0052）;对于多发肝转移瘤患者,单纯介入治疗与单纯化疗的MSR差异无统计学意义。原发肿瘤大小、腋窝淋巴结转移数、雌激素受体状态、肝转移后转氨酶异常程度、肝转移灶大小是影响预后的重要因素。结论 有效的化疗（尤其是含紫杉类方案化疗）和介入治疗能明显改善乳腺癌肝转移患者的预后。

Clinical characteristics and potential prognostic factors of breast cancer patients with liver metastases

Objective To analyze the clinical characteristics, efficiency of treatment and potential prognostic factors of breast cancer patients with liver metastases (BCLM). Methods The data of clinical characteristics, response to treatment and survival were retrospectively analyzed in 152 breast cancer patients with liver metastasis using SPSS 11. 5. Results The median disease free survival (DPS), the median survival of recurrence (MSR) and median time to progress (TTP) of this series was 21 months, 16 months and 7. 4 months, respectively. The response rate in chemotherapy group was higher than that in the transcatheter arterial chemoembolization (TACE) group (37.7% vs. 53%, P = 0.039). The TTP was longer (7 m vs. 10 m, P=0.048) and the response rate (63.3% vs.40.0% , P=0.04) in taxanes-based chemotherapy group was significantly higher than that in non-taxanes-containing regimen. The MSR in patients with single liver metastases treated by TACE was longer than that by chemotherapy (16 m vs. 30 m, P =0.0052) , but it was not observed in the patients with multiple metastases. Pathological tumor size (PT) and axillary lymph node status at diagnosis, negative estrogen receptor (ER) status, abnormal ALT level induced by liver metastases, metastastic tumor size were significantly correlated with shorter survival. Conclusion The effective chemotherapy especially the taxane-containing regimen and TACE may improve outcome for breast cancer patient with liver metastasis.