乳腺癌肝转移肝切除术后患者预后影响因素分析

doi:10.3877/cma.j.issn.2095-3232.2020.04.008

中华肝脏外科手术学电子杂志 ›› 2020, Vol. 09 ›› Issue (04) : 329 -332. doi: 10.3877/cma.j.issn.2095-3232.2020.04.008

所属专题：文献；

临床研究

乳腺癌肝转移肝切除术后患者预后影响因素分析

徐伟熙¹, 陈钦昌², 翁子晋³, 邱万寿⁴, 黄泽楠⁴^,^†(

)

^1. 510630　广州，中山大学附属第三医院甲乳外科；523900　广东省东莞市虎门医院普通外科
^2. 510080　广州，中山大学附属第一医院普通外科
^3. 510630　广州，中山大学附属第三医院病理科
^4. 510630　广州，中山大学附属第三医院甲乳外科

收稿日期:2020-04-06 出版日期:2020-08-10
通信作者: 黄泽楠
基金资助:
国家自然青年科学基金(81502271); 广东省药学会女性肿瘤用药研究基金项目(2014D09)

Prognostic factors for patients with breast cancer liver metastases after hepatectomy

Weixi Xu¹, Qinchang Chen², Zijin Weng³, Wanshou Qiu⁴, Zenan Huang⁴^,^†()

^1. Department of Thyroid and Breast Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China; Department of General Surgery, Humen Hospital of Dongguan, Dongguan 523900, China
^2. Department of General Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
^3. Department of Pathology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
^4. Department of Thyroid and Breast Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China

Received:2020-04-06 Published:2020-08-10
Corresponding author: Zenan Huang
About author:
Corresponding author: Huang Zenan, Email: sumshzn@163.com

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徐伟熙, 陈钦昌, 翁子晋, 邱万寿, 黄泽楠. 乳腺癌肝转移肝切除术后患者预后影响因素分析[J]. 中华肝脏外科手术学电子杂志, 2020, 09(04): 329-332.

Weixi Xu, Qinchang Chen, Zijin Weng, Wanshou Qiu, Zenan Huang. Prognostic factors for patients with breast cancer liver metastases after hepatectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(04): 329-332.

目的

探讨乳腺癌肝转移肝切除术后患者预后的影响因素。

方法

回顾性分析2000年1月1日至2017年12月31日在中山大学附属第三医院和中山大学附属第一医院行肝切除术的51例乳腺癌肝转移患者临床资料。患者均为女性；年龄41～72岁，中位年龄59岁。患者均签署知情同意书，符合医学伦理学规定。分析乳腺癌肝转移患者临床病理特征和生存影响因素。生存预后的单因素分析采用Log-rank检验，多因素分析采用Cox比例风险模型。

结果

肝转移灶直径中位数为25（15～50）mm，病灶数量为2（1～3）个。肝转移灶局限于单叶者38例，多叶者13例；手术切缘阴性46例，阳性切缘5例；雌激素受体（ER）阳性34例，孕激素受体（PR）阳性30例。单因素分析显示，肝转移灶直径、手术切缘、肝转移肿瘤ER与患者总体生存相关（HR=1.12，1.54，1.38；P<0.05）。多因素分析结果显示，肝转移灶直径>2.5 cm和手术切缘阳性是乳腺癌肝转移切除术后总体生存的独立危险因素（HR=1.02，1.43；P<0.05）。

结论

乳腺癌肝转移病灶以多发为主，多局限于单叶，病灶较小。肝转移灶直径和手术切缘是乳腺癌肝转移肝切除术后总体生存的独立影响因素。

关键词: 乳腺肿瘤, 肿瘤转移, 肝切除术, 预后

Objective

To explore the prognostic factors for patients with breast cancer liver metastases after hepatectomy.

Methods

Clinical data of 51 patients with breast cancer liver metastases who underwent hepatectomy at the Third and the First Affiliated Hospital of Sun Yat-sen University from January 1, 2000 to December 31, 2017 were retrospectively analyzed. All the patients were female, aged 41-72 years with a median of 59 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Clinicopathological features and survival prognostic factors for the patients were analyzed. Univariate factor analysis for survival prognosis was performed using Log-rank test, and multivariate factor analysis was performed using Cox proportional hazard model.

Results

The median diameter of liver metastases was 25(15-50) mm and the number was 2(1-3). Liver lesions of 38 cases localized in single lobe and lesions of 13 cases in multiple lobes. Negative surgical margin was observed in 46 cases and positive in 5 cases. Positive estrogen receptor (ER) was observed in 34 cases and positive progesterone receptor (PR) in 30 cases. Univariate analysis indicated that diameter of liver metastases, surgical margin, and ER were associated with the overall survival (HR=1.12, 1.54, 1.38; P<0.05). Multivariate analysis showed that tumor diameter >2.5 cm and positive surgical margin were the independent risk factors for the overall survival after resection of liver metastases from breast cancer (HR=1.02, 1.43; P<0.05).

Conclusions

Liver metastases from breast cancer are mainly multiple lesions, confining to single lobe with minor diameter. Diameter of liver metastases and surgical margin were the independent factors for the overall survival of patients after resection of liver metastases from breast cancer.

Key words: Breast neoplasms, Neoplasm metastasis, Hepatectomy, Prognosis

表1 乳腺癌肝转移切除术后总体生存的影响因素分析

临床病理特征	单因素分析			多因素分析
临床病理特征	HR	95%CI	P值	HR	95%CI	P值
年龄>60岁	1.08	0.91～1.17	0.27	?	?	?
乳腺癌T3～T4期	1.27	0.84～1.27	0.37	?	?	?
乳腺癌淋巴结转移	1.69	0.79～3.24	0.24	?	?	?
乳腺癌ER（-）	1.39	0.44～1.89	0.71	?	?	?
乳腺癌PR（-）	2.32	0.86～4.79	0.43	?	?	?
肝转移灶直径>25 mm	1.12	1.09～1.24	<0.001	1.02	1.01～1.09	<0.001
肝转移灶多发	1.23	0.94～1.56	0.26	?	?	?
转移灶切缘阳性	1.54	1.24～3.41	<0.001	1.43	1.13～1.69	<0.001
肝转移灶多叶分布	1.62	0.87～2.32	0.36	?	?	?
肝转移灶ER（-）	1.38	1.17～2.03	<0.001	1.35	0.42～2.14	0.329
肝转移灶PR（-）	1.32	0.79～3.14	0.22	?	?	?

表1 乳腺癌肝转移切除术后总体生存的影响因素分析

临床病理特征	单因素分析			多因素分析
临床病理特征	HR	95%CI	P值	HR	95%CI	P值
年龄>60岁	1.08	0.91～1.17	0.27	?	?	?
乳腺癌T3～T4期	1.27	0.84～1.27	0.37	?	?	?
乳腺癌淋巴结转移	1.69	0.79～3.24	0.24	?	?	?
乳腺癌ER（-）	1.39	0.44～1.89	0.71	?	?	?
乳腺癌PR（-）	2.32	0.86～4.79	0.43	?	?	?
肝转移灶直径>25 mm	1.12	1.09～1.24	<0.001	1.02	1.01～1.09	<0.001
肝转移灶多发	1.23	0.94～1.56	0.26	?	?	?
转移灶切缘阳性	1.54	1.24～3.41	<0.001	1.43	1.13～1.69	<0.001
肝转移灶多叶分布	1.62	0.87～2.32	0.36	?	?	?
肝转移灶ER（-）	1.38	1.17～2.03	<0.001	1.35	0.42～2.14	0.329
肝转移灶PR（-）	1.32	0.79～3.14	0.22	?	?	?

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