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目的探讨乳腺癌患者骨髓转移临床表现的特殊性、转移规律及治疗策略。方法回顾性分析62例女性乳腺癌骨髓转移患者的临床及随访资料,包括乳腺癌骨髓转移发生时间、激素受体状况等及不同治疗策略对预后的影响。24例联合化疗,25例单药化疗,13例未接受化疗。生存率用Kaplan-Meier方法计算,用Log-rank方法进行生存曲线比较。结果62例患者中位年龄39岁(30～71岁),中位病程21个月(1～49个月)。雌激素受体(ER)和(或)孕激素受体(PR)阳性患者30例(48.4%),阴性19例(30.6%)。发热14例(22.6%)和(或)血象的一系或三系降低34例(62.9%)是乳腺癌骨髓转移的常见表现。联合化疗和单药化疗中位生存期分别为10个月和16个月(QPH=7.38,P=0.0335),未接受化疗者中位生存期仅1个月。骨髓转移发生偏晚,一般有多处转移尤其是骨转移的背景。结论骨髓穿刺有利于早期发现骨髓转移;骨髓转移晚期体质较弱,单药化疗可能是有效的治疗策略之一,与联合化疗组的患者相比具有生存优势。
Objective To investigate the clinical manifestations of bone marrow metastasis in breast cancer patients with specific, metastatic and therapeutic strategies. Methods The clinical data and follow-up data of 62 cases of breast cancer patients with bone marrow metastasis were retrospectively analyzed, including the time of bone marrow metastasis and hormone receptor status in breast cancer and the influence of different treatment strategies on prognosis. 24 cases of combined chemotherapy, 25 cases of single-agent chemotherapy, 13 cases did not receive chemotherapy. Survival rates were calculated using the Kaplan-Meier method and survival curves were compared using the Log-rank method. Results The median age of 62 patients was 39 years (range, 30-71 years). The median duration of disease was 21 months (range 1-49 months). Thirty patients (48.4%) were estrogen receptor (ER) and / or progesterone receptor (PR) positive, and 19 patients (30.6%) were negative. Fever in 14 cases (22.6%) and / or hemophagocytic reduction of one or three lines in 34 cases (62.9%) is a common manifestation of breast cancer bone marrow metastasis. The median survival of combination chemotherapy and monotherapy was 10 months and 16 months (QPH = 7.38, P = 0.0335). The median survival of patients without chemotherapy was only 1 month. Bone marrow metastasis late, there are generally multiple metastases, especially bone metastases background. Conclusion Bone marrow aspiration is helpful for the early detection of bone marrow metastasis. Late stage of bone marrow metastasis is weak in constitution. Monotherapy may be one of the effective treatment strategies and has survival advantage compared with the combination chemotherapy group.