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目的探讨乳腺癌骨转移患者放疗后的预后情况。方法选取2008年1月至2013年5月间成都市核工业四一六医院收治的60例乳腺癌骨转移患者为研究对象。回顾性分析患者病历,并对患者进行1~3年的随访,收集记录患者放疗后的骨质破坏情况、绝经状态、碱性磷酸酶(ALP)值和血清钙等指标,统计患者初诊乳腺癌治疗后无病生存时间、骨外转移病灶和放疗有效率等情况,并进行比较分析。结果不成瘤乳腺癌患者初诊后无病生存期<2年的病例数占患者总数比例的87.5%,成瘤乳腺癌患者为12.5%;不成瘤乳腺癌患者有骨外转移病灶占患者总数比为88.9%,成瘤乳腺癌患者为11.1%;差异均有统计学意义(均P<0.05)。60例患者中,疼痛完全缓解患者46例(76.7%);部分缓解患者2例(3.3%);无缓解患者12例(20.0%)。疼痛完全缓解患者比例明显高于其他两类患者,差异有统计学意义(P<0.05)。患者放疗后1年生存率为58.3%(35/60),2年生存率为28.3%(17/60),3年生存率为13.3%(8/60)。患者骨转移病灶成瘤样改变、脊髓压迫和骨转移病灶数目是影响乳腺癌骨转移患者预后的独立因素,差异均有统计学意义(均P<0.05)。结论骨转移病灶成瘤样改变、脊髓压迫与骨转移病灶数目是影响患者放疗预后的独立危险因素,应加大对乳腺癌骨转移患者这几方面的观察及随访力度。
Objective To investigate the prognosis of patients with breast cancer with bone metastases after radiotherapy. Methods A total of 60 patients with bone metastases from breast cancer admitted to the No.416 Hospital of Chengdu Nuclear Industry from January 2008 to May 2013 were selected as the study subjects. Retrospective analysis of patients’ medical records, and follow-up of patients for 1 to 3 years, collecting records of bone destruction, postmenopausal status, alkaline phosphatase (ALP) values, serum calcium, etc., and statistics of patients with newly diagnosed breast cancer. After the treatment, the disease-free survival time, extra-bony metastatic lesions, and radiotherapy efficiency were analyzed and compared. Results The number of cases with disease-free survival less than 2 years after initial diagnosis of non-tumorous breast cancer patients accounted for 87.5% of the total number of patients, 12.5% of tumor-bearing breast cancer patients; the proportion of non-tumorous breast cancer patients with extraosseous metastatic lesions accounted for 88.9% of the patients with tumor-bearing breast cancer were 11.1%; the difference was statistically significant (both P<0.05). Of the 60 patients, 46 (76.7%) had complete pain relief, 2 (3.3%) partially relieved, and 12 (20.0%) had no remission. The proportion of patients with complete pain relief was significantly higher than the other two types of patients, the difference was statistically significant (P <0.05). The 1-year survival rate after radiotherapy was 58.3% (35/60), the 2-year survival rate was 28.3% (17/60), and the 3-year survival rate was 13.3% (8/60). The tumor-like changes of bone metastases, spinal cord compression, and number of bone metastatic lesions were independent factors influencing the prognosis of patients with bone metastases of breast cancer, and the differences were statistically significant (all P<0.05). Conclusion The tumor-like changes of bone metastases, spinal cord compression, and number of bone metastases are independent risk factors influencing the prognosis of patients with radiotherapy. The observation and follow-up of patients with bone metastases from breast cancer should be increased.