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目的分析三阴性乳腺癌(TNBC)首次复发转移部位的特征,以指导复发转移性TNBC患者的治疗选择及管理。方法回顾性分析125例复发转移性TNBC患者的临床资料,对术后常见的复发转移部位和复发转移时间进行描述和统计,归纳其首次复发转移的模式。结果 125例复发转移性TNBC患者中,首次单发转移部位以淋巴结和肺最为常见,分别占11.2%和5.6%;首发即为多发转移的比例高达79.2%,其中,含淋巴结、肺、骨、肝和脑转移的比例分别为52.8%、34.4%、27.1%、14.4%和6.4%,其他特殊部位(包含肾上腺等)转移32例(25.6%)。首发内脏转移(仅包含肝和肺)63例,占50.4%,其中6例同时有肝和肺转移;淋巴结转移比例最高,为64.0%;合并肺转移(40.0%)的患者明显多于肝转移(15.2%)的患者(P=0.000)。复发转移的时间多在术后2~3年,2年内复发者52例(41.6%),2~3年复发者23例(18.4%),3年以上复发者50例(40.0%)。结论 TNBC淋巴结、肺转移多见;脑转移作为首发部位也值得关注;TNBC多发转移比例高;多数在2~3年内复发。建议在辅助治疗后的随访中,除了关注淋巴结的检查外,还需关注肺部和颅脑的检查,以早期发现复发征象。
Objective To analyze the characteristics of the first recurrence and metastasis of triple negative breast cancer (TNBC) to guide the treatment selection and management of patients with recurrent metastatic TNBC. Methods The clinical data of 125 patients with recurrent metastatic TNBC were retrospectively analyzed. The recurrence and metastasis sites and the recurrence and metastasis time were described and statistically analyzed, and the pattern of the first recurrence and metastasis was summarized. Results Of the 125 patients with recurrent metastatic TNBC, the first single lymph node metastasis was lymph node and lung, accounting for 11.2% and 5.6% respectively. The incidence of multiple metastasis was 79.2% The rates of liver and brain metastases were 52.8%, 34.4%, 27.1%, 14.4% and 6.4%, respectively. Other special sites (including the adrenal gland) were metastasized in 32 cases (25.6%). Sixty-three cases had both liver and lung metastases, the highest proportion of lymph node metastasis was 64.0%, and the number of patients with combined lung metastasis (40.0%) was significantly higher than that of liver metastases (15.2%) of patients (P = 0.000). Recurrence and metastasis occurred mostly in 2 to 3 years after surgery, with 52 (41.6%) recurrences in 2 years, 23 (18.4%) in 2 to 3 years and 50 (40.0%) in 3 years. Conclusions TNBC lymph nodes and lung metastasis are common. Brain metastases as a starting site are also worth noting. TNBC has a high proportion of multiple metastases. The majority of recurrences occur within 2 to 3 years. Proposed adjuvant therapy in the follow-up, in addition to focus on lymph node examinations, but also need to pay attention to the lungs and brain examination, early detection of signs of recurrence.