长期生存复发转移性乳腺癌患者的临床病理特征和预后因素分析

目的分析复发转移后生存5年以上乳腺癌患者的临床病理特征和预后因素。方法1996年1月至2002年12月就诊、确诊时为Ⅰ-Ⅲ期、在之后的治疗随访过程中出现复发转移,且复发转移后生存期长于5年的乳腺癌患者72例,分析其临床病理特征、预后因素及治疗情况。结果全组患者复发转移时中位年龄46岁,原发肿瘤≤5cm者80.5%;腋窝淋巴结转移0～3个者69.5%;受体阳性者74.5%;以软组织转移为主者69.4%;中位无病生存期为31个月。一线治疗后完全缓解率为42.5%,中位完全缓解持续时间达26个月。COX多因素分析显示,腋窝淋巴结转移数目是总生存期（P=0.03）和复发转移后生存期（P=0.04）的独立预后因素。结论复发转移后长期生存的乳腺癌患者通常具有更多有利的临床病理指标并且在复发转移后接受了合理的综合治疗。腋窝淋巴结转移数目是独立的预后因素,有长期预测总生存和复发转移后生存期的价值。

The Clinical Characteristics and Prognostic Factors of Long-term Survived Patients with Recurrent and Metastatic Breast Cancer

Objective To analyze the clinical characteristics and prognostic factors of breast cancer patients who survived over 5 years after recurrence and metastasis. Methods Seventy-two breast cancer patients who survived over 5 years after recurrence and metastasis were retrospectively analyzed. To analyze the clinical characteristics, prognostic factors and therapeutic condition. Results The median age at recurrence or metastasis was 46 years. And 80.5% patients had primary tumors less than 5 cm;69.5% patients had 0-3 positive lymph nodes;74.5% were hormonal receptor positive; 69.4 % patients developed recurrence in soft tissue. The median DFS was 31 months. After first-line treatment,42.5 % patients achieved CR, and the median duration of CR was 26 months. After the multi-variants＇ cox regression analysis, we found the axillary lymph node status was the independent prognostic factor of overall survival（P=0.03） and post metastasis survival（P=0.04）. Conclusion Patients who survived over 5 years after recurrence and metastasis always have more favorable clinical and pathologic characteristics. The axillary lymph node status was the independent prognostic factor, and had the long-term prognostic value. After proper multimodality treatment,some recurrent and metastatic breast cancer patients can achieve long-term survival.