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目的 :探讨术后首发内脏转移三阴性乳腺癌的临床病理特点、一线化疗的情况及可能影响预后的因素。方法 :回顾性分析复旦大学附属肿瘤医院肿瘤内科2011年1月1日—2013年6月30日收治的107例术后首发内脏转移三阴性乳腺癌患者的临床资料、一线化疗情况和生存情况,并分析对预后影响的因素。结果 :全组107例患者,浸润性导管癌101例(94.4%),其他病理类型或混合性6例(5.6%)。术后中位无病间期为14.4个月,内脏转移后1、2和3年的生存率分别为75.7%、41.1%和22.4%。一线含铂方案化疗的客观有效率为60.0%,中位无进展生存时间为8.6个月;非铂方案化疗的客观有效率为36.2%,中位无进展生存时间为5.1个月,两者客观有效率和无进展生存时间差异均有统计学意义(P=0.014和P=0.023);含铂方案的中位生存期为19.9个月,非铂方案的中位生存期为20.9个月,两者间差异无统计学意义(P=0.423)。单因素分析结果显示,是否行新辅助化疗、术后是否放疗、肿瘤大小、淋巴结转移情况、临床分期、无病间期、一线化疗最佳疗效、是否为多内脏转移、一线化疗无进展生存时间均与预后有关(P值均<0.05)。多因素分析提示,是否行新辅助化疗和无病间期是影响术后首发内脏转移三阴性乳腺癌总生存期的独立预后因素(P值均<0.05)。结论 :术后首发内脏转移三阴性乳腺癌患者的无病间期短,远期生存率低,一线化疗含铂方案是良好选择,是否行新辅助化疗和无病间期不超过1年可能是其转移后总生存的独立预后因素。
Objective: To investigate the clinicopathological characteristics of first trimester visceral metastases and the first-line chemotherapy and the possible prognostic factors. Methods: A retrospective analysis of clinical data of 107 patients with first trimester visceral metastases from January 1, 2011 to June 30, 2013 in the Department of Oncology, Affiliated Tumor Hospital of Fudan University, first-line chemotherapy and survival were performed. And analyze the factors that affect the prognosis. Results: A total of 107 patients with invasive ductal carcinoma in 101 cases (94.4%), other pathological types or mixed in 6 cases (5.6%). The median duration of disease-free disease was 14.4 months, and the survival rates at 1, 2, and 3 years after visceral metastasis were 75.7%, 41.1% and 22.4%, respectively. The objective effective rate of first-line platinum regimen chemotherapy was 60.0% and the median progression-free survival time was 8.6 months. The objective response rate of non-platinum regimen chemotherapy was 36.2%, and the median progression-free survival time was 5.1 months. There was significant difference between the effective and progression-free survival time (P = 0.014 and P = 0.023). The median survival time of the platinum-containing regimen was 19.9 months, and the median survival time of the non-platinum regimen was 20.9 months. There was no significant difference between the two groups (P = 0.423). Univariate analysis showed that whether neoadjuvant chemotherapy, postoperative radiotherapy, tumor size, lymph node metastasis, clinical stage, disease-free interval, the best effect of first-line chemotherapy, whether more visceral metastasis, first-line chemotherapy progression-free survival time All were related to prognosis (P <0.05). Multivariate analysis suggested that whether neoadjuvant chemotherapy and disease-free interval were independent prognostic factors affecting the overall survival of patients with triple negative breast cancer after initial gut metastasis (P <0.05). CONCLUSIONS: The patients with first-episode visceral metastasis of triple-negative breast cancer have a short disease-free period and a low long-term survival rate. The first-line platinum-containing regimen is a good choice. Whether neoadjuvant chemotherapy and disease-free period is less than 1 year may be Its independent prognostic factor for overall survival after metastasis.