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中华乳腺病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (05) : 274 -279. doi: 10.3877/cma.j.issn.1674-0807.2020.05.003

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论著

乳腺癌骨转移患者临床病理特征及预后影响因素分析:基于SEER数据库的回顾性研究
崔军威1, 刘晓岭1, 胡艺冰1, 杨子健1, 付阳1, 高睿1, 何劲松1, 韦伟1,()   
  1. 1. 518036 深圳,北京大学深圳医院乳腺外科
  • 收稿日期:2020-01-04 出版日期:2020-10-01
  • 通信作者: 韦伟
  • 基金资助:
    广东省深圳市三名工程资助项目(SZSM201612010); 广东省医学科学技术研究项目基金(A2020288)

Clinicopathological characteristics and prognostic factors in breast cancer patients with bone metastasis: a retrospective study based on the SEER database

Junwei Cui1, Xiaoling Liu1, Yibin Hu1, Zijian Yang1, Yang Fu1, Rui Gao1, Jinsong He1, Wei Wei1,()   

  1. 1. Department of Breast Surgery, Shenzhen Hospital of Peking University, Shenzhen 518036, China
  • Received:2020-01-04 Published:2020-10-01
  • Corresponding author: Wei Wei
  • About author:
    Corresponding author: Wei Wei, Email:
引用本文:

崔军威, 刘晓岭, 胡艺冰, 杨子健, 付阳, 高睿, 何劲松, 韦伟. 乳腺癌骨转移患者临床病理特征及预后影响因素分析:基于SEER数据库的回顾性研究[J/OL]. 中华乳腺病杂志(电子版), 2020, 14(05): 274-279.

Junwei Cui, Xiaoling Liu, Yibin Hu, Zijian Yang, Yang Fu, Rui Gao, Jinsong He, Wei Wei. Clinicopathological characteristics and prognostic factors in breast cancer patients with bone metastasis: a retrospective study based on the SEER database[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2020, 14(05): 274-279.

目的

探讨乳腺癌骨转移患者的临床病理特征,并分析其预后情况及相关影响因素。

方法

根据纳入及排除标准,利用美国国立癌症研究所监测、流行病学和结果(SEER)数据库检索并筛选1975年1月至2016年12月5 815例转移性乳腺癌患者资料进行回顾性分析,评估了患者临床病理特征、治疗方式及其预后。其中,乳腺癌骨转移组3 146例,乳腺癌非骨转移组2 669例。按照预后情况,将3 146例乳腺癌骨转移患者分为2个亚组:死亡组1 669例和存活组1 477例。利用χ2检验和Mann-Whitney U检验比较骨转移和非骨转移组患者临床病理特征的差异;用二元Logistic回归分析乳腺癌骨转移的影响因素;用Kaplan-Meier法进行生存分析,并用单因素log-rank检验分析乳腺癌骨转移患者中死亡组与存活组临床病理特征的差异;用多因素Cox比例风险回归模型筛选影响乳腺癌骨转移者生存情况的独立因素。

结果

骨转移组和非骨转移组患者在T分期、N分期、组织学分级、人种、ER、PR、HER-2、肿瘤分子分型和预后方面比较,差异均有统计学意义(Z=-5.71、-2.39、-13.87、χ2=14.55、305.74、245.56、69.34、335.36、79.15,P均<0.050),2组间年龄、性别和原发灶位置比较,差异均无统计学意义(χ2=0.57、2.71、0.45,P均>0.050)。Logistic回归分析结果显示:ER阳性、PR阳性、肿瘤T分期高和N分期高为导致乳腺癌患者骨转移的危险因素(OR=1.775,95%CI:1.258~2.505,P=0.001;OR=1.425,95%CI: 1.236~1.643,P<0.001;OR=1.095,95%CI:1.043~1.149,P<0.001;OR=1.396,95%CI: 1.246~1.564,P<0.001),而组织学分级越高,发生骨转移的风险反而越小(OR=0.815,95%CI:0.733~0.907,P<0.001)。骨转移组与非骨转移组患者的OS比较,差异均具有统计学意义(χ2=133.53,P<0.001)。骨转移患者中,2个亚组(死亡组和存活组)患者在T分期、N分期、组织学分级、年龄、ER、PR、HER-2、肿瘤分子分型、原发灶手术、放射治疗和化疗方面比较,差异均有统计学意义(Z=-7.75、-3.22、-8.14、χ2=39.80、69.81、87.45、51.87、132.47、36.24、6.05、36.24,P均<0.050)。Cox比例风险回归模型多因素分析结果显示:年龄、T分期、N分期、PR、HER-2、肿瘤分子分型、组织学分级、化疗、放射治疗和原发灶手术是影响骨转移组患者预后的独立因素(HR=1.349,95%CI: 1.195~1.523,P<0.001;HR=1.151,95%CI: 1.101~1.203,P<0.001;HR= 1.077,95%CI: 1.033~1.123,P<0.001;HR= 0.715,95%CI: 0.626~0.817,P<0.001;HR=0.695,95%CI: 0.627~0.770,P<0.001;HR=1.349,95%CI: 1.260~1.414,P<0.001;HR=1.371,95%CI: 1.261~1.489,P<0.001;HR=0.626,95%CI:0.562~0.697,P<0.001;HR=0.874,95%CI:0.791~0.966,P=0.008;HR=0.663,95%CI: 0.561~0.784,P<0.001)。

结论

乳腺癌骨转移患者预后优于非骨转移患者,与年龄、T分期、N分期、PR、HER-2、肿瘤分子分型、组织学分级有关,治疗方面原发灶手术、放射治疗和化疗有助于改善骨转移患者的预后。

Objective

To explore the clinicopathological characteristics of breast cancer patients with bone metastasis, and analyze their prognosis and related influencing factors.

Methods

According to the inclusion and exclusion criteria, totally 5 815 patients with metastatic breast cancer from January 1975 to December 2016 were screened out from the Surveillance, Epidemiology and Results (SEER) database of the U. S. National Cancer Institute for a retrospective analysis. The clinicopathological characteristics, treatment methods and prognosis of patients were evaluated. Among them, there were 3 146 patients with bone metastasis and 2 669 without. According to their prognosis, 3 146 patients with bone metastasis were divided into two subgroups: 1 669 patients in the death group and 1 477 patients in the survivor group. The χ2 test and Mann-Whitney U test were used to compare the clinicopathological characteristics between bone metastasis group and non-bone metastasis group, binary Logistic regression was used to analyze the influencing factors of bone metastasis in breast cancer, the Kaplan-Meier method was used for survival analysis. The univariate log-rank test was used to analyze clinicopathological characteristics between the dead cases and survivors in 3 146 patients with bone metastasis, and the multivariate Cox proportional hazards regression model was used to find risk factors affecting the survival of patients.

Results

There were significant differences in T stage, N stage, pathological grade, race, ER, PR, HER-2, molecular subtyping and prognosis between the bone metastasis group and non-bone metastasis group (Z=-5.71, -2.39, -13.87, χ2=14.55, 305.74, 245.56, 69.34, 335.36, 79.15, all P<0.050), while patient age, gender and position of primary tumor presented no significant difference (χ2=0.57, 2.71, 0.45, all P>0.050). The result of Logistic regression analysis showed that ER positive, PR positive, advanced T stage and advanced N stage were independent risk factors of bone metastasis in breast cancer patients(OR=1.775, 95%CI: 1.258-2.505, P=0.001; OR=1.425, 95%CI: 1.236-1.643, P<0.001; OR=1.095, 95%CI: 1.043-1.149, P<0.001; OR=1.396, 95%CI: 1.246-1.564, P<0.001), while advanced pathological stage indicated lower risk of bone metastasis (OR=0.815, 95%CI: 0.733-0.907, P<0.001). The overall survival showed a significant difference between the bone metastasis group and non-bone metastasis group (χ2=133.53, P<0.001). In patients with bone metastasis, there were significant differences in T stage, N stage, pathological grade, patient age, ER, PR, HER-2, molecular subtyping, primary tumor surgery, chemotherapy and radiation therapy between death group and survivor group (Z=-7.75, -3.22, -8.14, χ2=39.80, 69.81, 87.45, 51.87, 132.47, 36.24, 6.05, 36.24, all P<0.050). The multivariate analysis of Cox proportional hazards model showed that patient age, T stage, N stage, PR, HER-2, molecular subtyping, pathological grade, chemotherapy, radiotherapy and primary tumor surgery were independent factors affecting the prognosis of breast cancer patients with bone metastasis(HR =1.349, 95%CI: 1.195-1.523, P<0.001; HR=1.151, 95%CI: 1.101-1.203, P<0.001; HR=1.077, 95%CI: 1.033-1.123, P<0.001; HR= 0.715, 95%CI: 0.626-0.817, P<0.001; HR=0.695, 95%CI: 0.627-0.770, P<0.001; HR=1.349, 95%CI: 1.260-1.414, P<0.001; HR=1.371, 95%CI: 1.261-1.489, P<0.001; HR=0.626, 95%CI: 0.562-0.697, P<0.001; HR=0.874, 95%CI: 0.791-0.966, P=0.008; HR=0.663, 95%CI: 0.561-0.784, P<0.001).

Conclusion

The prognosis of breast cancer patients with bone metastasis is superior to that of the patients with non-bone metastasis, related to patient age, T stage, N stage, PR, HER-2, molecular subtyping and pathological grade. Primary tumor surgery, radiotherapy and chemotherapy can significantly improve the prognosis of patients with bone metastasis.

表1 5 815例转移性乳腺癌患者骨转移影响因素Logistic回归分析变量赋值表
表2 3 146例乳腺癌骨转移患者预后影响因素Cox回归分析变量赋值表
图1 乳腺癌骨转移组和非骨转移组患者的总生存曲线
表3 骨转移组和非骨转移组乳腺癌患者临床病理特征比较[例(%)]
临床病理特征 骨转移组(n=3 146) 非骨转移组(n=2 669) 检验值 P
年龄        
  ≤50岁 817(26.0) 670(25.1) χ2=0.57 0.450
  >50岁 2 329(74.0) 1 999(74.9)
性别        
  女性 3 089(98.2) 2 635(98.7) χ2=2.71 0.100
  男性 57(1.8) 34(1.3)
人种        
  白种人 2 458(78.1) 1 978(74.1) χ2=14.55 0.001
  黑种人 464(14.8) 488(18.3)
  其他 224(7.1) 203(7.6)
原发灶位置a        
  右侧乳腺 1 509(48.1) 1 300(48.9) χ2=0.45 0.800
  左侧乳腺 1 629(51.9) 1 361(51.1)
T分期b        
  T1 419(13.9) 306(11.9) Z=-5.71 <0.001
  T2 1 157(38.3) 852(33.2)
  T3 575(19.1) 445(17.3)
  T4 866(28.7) 966(37.6)
N分期c        
  N0 631(20.9) 564(22.1) Z=-2.39 0.017
  N1 1 131(37.5) 1 026(40.2)
  N2 596(19.7) 481(18.9)
  N3 662(21.9) 479(18.8)
ERd        
  阳性 2 519(81.8) 1 585(61.0) χ2=305.74 <0.001
  阴性 562(18.2) 1 015(39.0)
PRe        
  阳性 2 096(68.3) 1 241(47.8) χ2=245.56 <0.001
  阴性 972(31.7) 1 357(52.2)
HER-2f        
  阳性 689(22.6) 833(32.4) χ2=69.34 <0.001
  阴性 2 286(75.1) 1 676(65.2)
  不确定 68(2.3) 61(2.4)
肿瘤分子分型i        
  luminal A 1 967(66.2) 1 094(43.7) χ2=335.36 <0.001
  luminal B 491(16.5) 477(19.0)
  HER-2过表达 198(6.7) 356(14.2)
  三阴性 314(10.6) 577(23.1)
组织学分级        
  1级(高分化) 268(8.5) 109(4.1) Z=-13.87 <0.001
  2级(中分化) 1 339(42.6) 785(29.4)
  3级(低分化) 1 523(48.4) 1 747(65.5)
  4级(未分化) 16(0.5) 28(1.0)
预后        
  生存 1 477(46.9) 945(35.4) χ2=79.15 <0.001
  死亡 1 669(53.1) 1 724(64.6)
表4 乳腺癌骨转移影响因素的Logistic回归分析(n=5 815)
表5 死亡组和存活组乳腺癌骨转移患者的临床病理特征比较[例(%)]
临床病理特征 死亡组(n=1 669 ) 存活组(n=1 477) 检验值 P
年龄        
  ≤50岁 356(21.3) 461(31.2) χ2=39.80 <0.001
  >50岁 1 313(78.7) 1 016(68.8)
性别        
  男性 34(2.0) 23(1.6) χ2=1.02 0.314
  女性 1 635(98.0) 1 454(98.4)
人种        
  白种人 1 311(78.6) 1 147(77.7) χ2=3.92 0.141
  黑种人 253(15.2) 211(14.3)
  其他 105(6.2) 119(8.0)
原发灶位置a        
  右侧 789(47.5) 720(48.7) χ2=0.49 0.486
  左侧 872(52.5) 757(51.3)
T分期b        
  T1 173(10.9) 246(17.2) Z=-7.75 <0.001
  T2 564(35.5) 593(41.6)
  T3 322(20.3) 253(17.7)
  T4 531(33.3) 335(23.5)
N分期c        
  N0 327(20.7) 304(21.1) Z=-3.22 <0.001
  N1 573(36.3) 558(38.7)
  N2 301(19.1) 295(20.4)
  N3 376(23.9) 286(19.8)
ERd        
  阳性 1 243(76.4) 1 276(87.7) χ2=69.81 <0.001
  阴性 383(23.6) 179(12.3)
PRe        
  阳性 989(61.2) 1 107(76.2) χ2=87.45 <0.001
  阴性 626(38.8) 346(23.8)
HER-2f        
  阳性 296(18.6) 393(27.1) χ2=51.87 <0.001
  阴性 1 253(78.6) 1 033(71.3)
  不确定 45(2.8) 23(1.6)
肿瘤分子分型i        
  luminal A 1 006(65.1) 961(67.5) χ2=132.47 <0.001
  luminal B 198(12.8) 293(20.6)
  HER-2过表达 98(6.3) 100(7.0)
  三阴性 244(15.8) 70(4.9)
组织学分级        
  1级(高分化) 118(7.1) 150(10.2) Z=-8.14 <0.001
  2级(中分化) 620(37.1) 719(48.7)
  3级(低分化) 919(55.1) 604(40.9)
  4级(未分化) 12(0.7) 4(0.2)
化疗        
  905(54.2) 957(64.8) χ2=36.24 <0.001
  764(45.8) 520(35.2)
放射治疗        
  727(43.6) 708(47.9) χ2=6.05 0.014
  942(56.4) 769(52.1)
原发灶手术        
  905(54.2) 957(64.8) χ2=36.24 <0.001
  764(45.8) 520(35.2)
表6 乳腺癌骨转移患者预后影响因素的Cox回归分析(n=3 146)
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