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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (02) : 98 -103. doi: 10.3877/cma.j.issn.1674-0807.2020.02.007

所属专题： 文献；

论著

乳腺癌患者早期骨转移的危险因素分析
陈旭1, 胡乐1, 楼龙泉1, 于子溢1, 刘晓安1, 王水1, 肇毅1,†()   
  1. 1. 210029　南京医科大学第一附属医院乳腺科
  • 收稿日期:2017-05-30 出版日期:2020-04-01
  • 通信作者: 肇毅

Risk factors of early bone metastasis in breast cancer patients

Xu Chen1, Le Hu1, Longquan Lou1, Ziyi Yu1, Xiaoan Liu1, Shui Wang1, Yi Zhao1,†()   

  1. 1. Department of Breast Diseases, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
  • Received:2017-05-30 Published:2020-04-01
  • Corresponding author: Yi Zhao
  • About author:
    Corresponding author: Zhao Yi, Email:
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引用本文：

陈旭, 胡乐, 楼龙泉, 于子溢, 刘晓安, 王水, 肇毅. 乳腺癌患者早期骨转移的危险因素分析[J/OL]. 中华乳腺病杂志(电子版), 2020, 14(02): 98-103.

Xu Chen, Le Hu, Longquan Lou, Ziyi Yu, Xiaoan Liu, Shui Wang, Yi Zhao. Risk factors of early bone metastasis in breast cancer patients[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2020, 14(02): 98-103.

目的

探讨乳腺癌患者术后2年内发生早期骨转移的危险因素。

方法

回顾性分析2008年1月至2016年12月在南京医科大学第一附属医院就诊的146例乳腺癌骨转移患者资料。采用Kaplan-Meier生存曲线及log-rank检验比较不同年龄、原发肿瘤大小、腋窝淋巴结转移数目及分子分型的乳腺癌患者无骨转移时间(BFT)的差异。采用Cox比例风险回归模型分析乳腺癌早期骨转移的危险因素。

结果

146例乳腺癌骨转移患者中位BFT为25.9个月(范围：0.1～201.3个月)。确诊乳腺癌的年龄≥59岁、肿瘤分期T2及以上、腋窝淋巴结转移数目≥10枚均为乳腺癌早期骨转移的危险因素(χ2＝18.42，P<0.001；χ2＝21.71，P<0.001；χ2＝30.79，P<0.001)。患者年龄≥59岁、肿瘤分期T2及以上、腋窝淋巴结转移数目≥10枚均为乳腺癌早期骨转移的独立危险因素(HR＝2.392，95%CI: 1.367～4.184，P＝0.002；HR＝2.159，95%CI: 1.061～4.393，P＝0.034；HR＝1.964，95%CI: 1.167～3.305，P＝0.011)。

结论

高龄、原发肿瘤直径大、腋窝淋巴结转移数目多的乳腺癌患者更易发生早期骨转移。

关键词: 乳腺肿瘤, 肿瘤转移, 危险因素
Objective

To explore the risk factors of early bone metastasis in breast cancer patients within postoperative two years.

Methods

The clinical data of 146 breast cancer patients with bone metastasis in the First Affiliated Hospital of Nanjing Medical University from January 2008 to December 2016 were analyzed retrospectively. The Kaplan-Meier survival curve and log-rank test were used to compare the bone metastasis-free time (BFT) among patients with different ages, tumor sizes, metastatic lymph node numbers and molecular subtypes. Cox’s proportional hazards regression model was used to analyze the risk factors of early bone metastasis.

Results

In 146 breast cancer patients with bone metastasis, the median BFT was 25.9 months (range: 0.1-201.3 months). Age ≥59 years (χ2=18.42, P<0.001), tumor stage≥T2 (χ2=21.71, P<0.001), metastatic lymph nodes≥10(χ2=30.79, P<0.001)were risk factors of early bone metastasis in breast cancer patients. Age≥59 years, tumor stage≥T2 and metastatic lymph nodes≥10 were identified as independent risk factors of early bone metastasis in breast cancer patients (HR=2.392, 95%CI: 1.367-4.184, P=0.002; HR=2.159, 95%CI: 1.061-4.393, P=0.034; HR=1.964, 95%CI: 1.167-3.305, P=0.011).

Conclusion

The breast cancer patients with higher age, larger diameter of primary tumor or more metastatic axillary lymph nodes are more prone to early bone metastasis.

Key words: Breast neoplasms, Neoplasm metastasis, Risk factors
表1 146例乳腺癌骨转移患者Cox比例风险回归模型变量赋值情况
变量 变量类型 变量分类及赋值
年龄 X1 <59岁＝0，≥59岁＝1
T分期 X2 T1＝1，T2＝2，T3及以上＝3
ER X3 阴性＝0，阳性＝1
PR X4 阴性＝0，阳性＝1
HER-2 X5 阴性＝0，阳性＝1
Ki67 X6 ≤14%＝0, >14%＝1
腋窝淋巴结转移数目 X7 <10枚＝0，≥10枚＝1
分子分型 X8 luminal A型＝1, luminal B型＝2, HER-2过表达型＝3,三阴性乳腺癌＝4
无骨转移时间 Y <2年＝1，≥2年＝0
表2 146例乳腺癌骨转移患者的临床病理特征
临床病理特征 例数 构成比(%)
年龄 ? ?
? <59岁 118 80.8
? ≥59岁 28 19.2
无骨转移时间 ? ?
? <24个月 67 45.9
? ≥24个月 79 54.1
T分期 ? ?
? T1 39 26.7
? T2 96 65.8
? T3和T4 11 7.5
ER ? ?
? 阳性 107 73.3
? 阴性 39 26.7
PR ? ?
? 阳性 91 62.3
? 阴性 55 37.7
HER-2 ? ?
? 阳性 62 42.5
? 阴性 84 57.5
Ki67 ? ?
? ≤14% 33 22.6
? >14% 113 77.4
分子分型 ? ?
? luminal A 22 15.1
? luminal B 88 60.3
? HER-2过表达型 19 13.0
? 三阴性 17 11.6
腋窝淋巴结转移数目 ? ?
? <10枚 106 72.6
? ≥10枚 40 27.4
表3 乳腺癌患者骨转移病灶部位分布情况(处)
部位 病灶数(n＝320) 占总病灶数比例(%)
颅骨 12 3.7
胸部骨骼 98 30.6
? 肩胛骨 6 1.9
? 锁骨 5 1.5
? 胸骨 31 9.7
? 肋骨 56 17.5
脊柱椎体 113 35.3
? 腰椎 44 13.8
? 胸椎 65 20.3
? 颈椎 4 1.2
骨盆 69 21.6
? 骶骨及骶髂处 37 11.6
? 髂骨 28 8.8
? 坐骨 4 1.2
? 耻骨 0 0
肢体 28 8.8
? 上肢骨 6 1.9
? 下肢骨 22 6.9
图1 不同分组的乳腺癌患者无骨转移生存曲线比较　a、b、c、d图分别为不同年龄、T分期、腋窝淋巴结转移数目、分子分型乳腺癌患者的无骨转移生存曲线
表4 146例乳腺癌患者早期骨转移影响因素的Cox比例风险回归分析
变量 回归系数 标准误 Wald值 HR值 95%CI P值
年龄 0.872 0.285 9.342 2.392 1.367～4.184 0.002
T2 0.770 0.362 4.509 2.159 1.061～4.393 0.034
T3/T4 1.176 0.513 5.253 3.243 1.186～8.869 0.022
腋窝淋巴结转移数目 0.675 0.266 6.457 1.964 1.167～3.305 0.011
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