乳腺癌恶性胸腔积液的临床特征及预后因素分析

目的研究有症状乳腺癌恶性胸腔积液患者的临床特征及影响疗效的相关因素。方法回顾性总结分析了2008年11月至2010年12月我科收治的36例有症状胸腔积液乳腺癌患者的一般临床资料年龄、东部肿瘤协作组(ECOG)、手术病理分期、手术后无病生存期(DFS)、胸腔积液是否为初次复发部位、是否复发后一线化疗、是否伴有其他积液、是否双侧胸腔积液],胸腔积液的情况是否血性胸腔积液、胸水细胞数、胸水单核细胞数、乳酸脱氢酶(LDH)、癌胚抗原(CEA)、CA153、CA125、蛋白、胸水量]及胸腔积液的治疗情况(胸腔局部治疗方式、胸腔局部化疗药物、是否使用IL-2)中各种因素对于胸腔积液疗效及控制时间的影响。结果患者手术至出现胸腔积液的中位时间44月(0～180月)。手术至出现胸腔积液的时间>44月有效率显著高于手术后DFS≤44月者(P=0.046),分别为66.7%,33.3%;复发后一线化疗者有效率显著高于复发后二线及以上化疗者(P=0.044),分别为65.0%和31.3%;胸水单核细胞数>1×106/L的患者有效率显著高于胸水单核细胞数≤1×106/L(P=0.046)的患者,分别为66.7%,33.3%。胸腔积液中位控制时间为4月,胸腔积液LDH≤400 u/ml较LDH>400 u/ml的患者的胸腔积液控制时间显著延长(P=0.032),胸腔积液中位控制时间分别为6月和2月。结论胸腔积液是乳腺癌患者常见的临床表现,术后DFS时间长、复发后一线化疗及胸水单核细胞高者有效率高,胸腔积液LDH浓度高是胸水控制时间短的不良预后因素。

Clinical Characteristics and Prognostic Factors in Breast Cancer with Malignant Pleural Effusion

Objective
To investigate the clinical characteristics and prognostic factors of the patients with breast cancer who had symptomatic malignant pleural effusion (MPE).
Methods
The data of 36 patients underwent pleurodesis for malignant pleural from Nov 2008 to Dec 2010 were collected. It included the patients' general clinical data (age, ECOG, surgical-pathological staging, postoperative DFS, the pleural effusion being the first recurrence,first-line chemotherapy, other effusion, and bilateral pleural effusion), details of pleural effusion (whether it was congestive pleural effusion, number of the effusion cells or not, number of monocytes, LDH, CEA, CA153, CA125, protein, and quantity of pleural effusion) and treatments of pleural effusion (local treatment, local chemotherapeutics, whether to use IL-2). The factors which influenced pleural effusion treatments and its time control under the above conditions were analyzed.
Results
The median time of the interval between surgery and the onset of MPE was 44 months(0-180 months). The patients with the interval time between surgery and onset of MPE longer than 44 months had higher response rate(66.7%) than those less than 44 months (33.3%)（P=0.046）.The patients receiving first line chemotherapy (65.0%) had higher response rate than those receiving more than first line chemotherapy (31.3%,P=0.044）.The mononuclear cell number in the pleural effusion influenced the response rate to a significant degree（P=0.046）. The median pleural effusion control time was 4 months.The patients with lactate dehydrogenase (LDH) concentration higher than 400 u/L(6 months) had longer median pleural effusion control time than those with LDH concentration lower than 400 u/L (2 months)(P=0.032).
Conclusion
Malignant pleural effusion was the common presentation for advanced breast cancer. The interval time between surgery and onset of MPE, first line chemotherapy and mononuclear cell number in the pleural effusion significantly affected the response rate.The LDH concentration in pleural effusion was a good predictor of pleural effusion control time.