乳腺癌肺转移的临床病程及治疗研究

目的探讨乳腺癌肺转移的临床病程特点与内科治疗结果。方法共收治１２２例乳腺癌肺转移患者。全部患者均行化疗或内分泌治疗,疗效评价按ＷＨＯ标准,生存率按寿命表法计算。结果原发癌初次治疗后出现肺转移的中位时间为２２个月,继发转移部位以肺内、肝、骨多见。治疗总有效率为４８％,其中ＣＲ率１５％。含ＤＤＰ方案的ＣＲ率（２１％）高于非ＤＤＰ方案（７％,Ｐ＜０．０５）,接受前者治疗的患者中位生存期比后者长;含蒽环类药方案的ＰＲ率（４８％）高于非蒽环类方案（２０％,Ｐ＜０．００１）,但两组患者的中位生存期相近;而化疗与化疗加内分泌治疗的ＣＲ与ＰＲ率差异无显著意义（Ｐ＞０．０５）。本组患者１,３,５和１０年生存率分别为７７％、２２％、１１％和１０％。影响生存期的因素包括近期疗效、原发肿瘤大小、无病间隙期、肺转移数目、是否合并其他部位转移等。结论本研究确定了乳腺癌肺转移的临床病程特征及预后因素。联合化疗特别是含ＤＤＰ的方案可能延长患者的生存期。

The clinical course and treatment results of lung metastases from breast cancer

Objective To analyse the clinical course and treatment result of lung metastases from breast cancer. Methods 122 cases with lung metastases from breast cancer were treated by chemotherapy or chemotherapy plus endocrine therapy. Treatment results were assessed according to WHO criteria and survival rate estimated using the life table. Results The median time from initial treatment of primary tumour to lung metastases was 22 months. Sites of common consecutive metastases were lung, liver and bone. The overall response rate was 48% with a CR rate of 15%. Compared to non DDP encompassing regimen, the CR rate was higher in DDP based chemotherapy (7% versus 21%, P <0.05) with a longer median survival time (MST). The PR rate was higher in regimen containing anthracycline (48%) than in that without anthracycline (20%, P <0.01). The response rate was similar between chemotherapy and chemotherapy plus endocrine therapy ( P >0.05). No difference in MST was observed between patients receiving anthracycline and non anthracycline encompassing regimens. The 1 ,3 ,5 and 10 year survival rate was 77%,22%,11% and 10%,respectively. The size of primary tumour, the length of disease free interval, the number of lung metastases may provide additional information for predicting patients' survival after treatment of lung metastases.Conclusion Combination chemotherapy, especially DDP based chemotherapy may prolong survival time of patients with lung metastases from breast cancer.