22例射频消融治疗乳腺癌肝转移的临床特征及疗效评估

发布时间：2018-04-24 05:21

本文选题：乳腺癌 + 肝转移　；参考：《浙江大学》2017年硕士论文

【摘要】：背景:乳腺癌是女性最常见的一种恶性肿瘤,每个女性一生中患乳腺癌的风险约有10%,大约20%的患者会经历局部复发或远处转移。在过去的数十年间,辅助治疗明显的改善了原发性乳腺癌患者的生存率。但是乳腺癌肝转移病人的预后依然很差。肝脏切除术以及局部消融术在结直肠癌肝转移患者中已经是公认的安全有效的疗法,这些技术对乳腺癌肝转移患者是否有效也成为了大家所关注的问题。本研究中就2007年到2016年在浙江大学医学院附属第二医院接受射频消融治疗的22例乳腺癌肝转移患者的临床特征及无进展生存期和总生存期进行分析,找到对于乳腺癌肝转移患者射频消融术后无进展生存期有影响的因素,并借此预估患者预后。资料与方法:回顾性分析了 2007年到2016年在浙江大学医学院附属第二医院接受射频消融治疗的具有详细病历资料及随访资料的22例乳腺癌肝转移患者临床特征、无进展生存期、总生存期及预后相关危险因素。详细记录了患者的性别、乳腺癌发病年龄、绝经时间、乳腺癌手术方式、乳腺癌原发灶病理结果、雌激素受体、孕激素受体、Cerb-2情况、原发灶腋窝淋巴结转移情况、确诊肝转移时合并其他部位转移情况、乳腺癌术后辅助治疗情况、确诊肝转移时间、初次行RFA治疗时间、RFA治疗后的辅助治疗情况、RFA术后无进展生存时间、总生存期、家族史、生育史等。分析这些临床特征对患者射频消融术后无进展生存期的影响。统计分析采用 Kaplan-Meier 法、log-rank 检验。结果:1.全组22例患者均为女性,中位发病年龄为46岁(28-65岁)。所有病例PFS时间为 2.3-93.2 月,中位 PFS 时间为 11.8±3.6 月(95%CI:4.7-18.9)。2.所有病例RFA术后生存时间为2.7-93.2月,中位生存时间为23.8±5.8月(95%CI:12.5-35.2)。确诊肝转移后生存时间为10.8-98.5月,中位生存时间为38.9±3.6 月(95%CI:36.8-46.1)。3.原发灶腋窝淋巴结转移情况、肝转移灶为单发灶或多发灶、乳腺癌手术后初次确诊肝转移的时间间隔、确诊肝转移后初次行RFA治疗的时间间隔与RFA术后PFS有相关性,但无显著性差异(P0.05)。4.未能证明乳腺癌发病年龄、乳腺癌发病时绝经状态、ER状态、PR状态、Her-2状态、肝转移灶单发或多发情况、确诊肝转移时是否合并其他部位转移等与PFS有显著相关性。结论:1.腋窝淋巴结分期、乳腺癌手术后初次确诊肝转移的时间间隔、确诊肝转移后初次行RFA治疗的时间间隔对RFA治疗后的PFS有影响,乳腺癌手术后发现肝转移越早、确诊肝转移后处理时间越早,预后越好;2.本研究中RFA术后无进展生存时间(11.8月)与文献报道(11月)相似。总生存期(38.9月)高于肝脏TACE术(26月),与肝脏切除术相似(20-67月)。3.乳腺癌肝转移患者可以从RFA术中获益。
[Abstract]:Background: breast cancer is the most common malignant tumor in women. Each woman has a lifetime risk of breast cancer, about 20% of patients experience local recurrence or distant metastasis. In the past decades, adjuvant therapy has significantly improved the survival rate of patients with primary breast cancer. But the prognosis of patients with liver metastases from breast cancer is still poor. Hepatectomy and local ablation have been recognized as safe and effective therapy in patients with liver metastases from colorectal cancer. Whether these techniques are effective in patients with liver metastasis of breast cancer has become a question of concern. From 2007 to 2016, 22 patients with liver metastases from breast cancer receiving radiofrequency ablation in the second affiliated Hospital of Zhejiang University Medical College were analyzed. To find out the factors influencing the progressive survival after radiofrequency ablation in patients with liver metastasis of breast cancer, and to predict the prognosis of the patients. Materials and methods: the clinical features of 22 patients with liver metastases from breast cancer received radiofrequency ablation in the second affiliated Hospital of Zhejiang University School of Medicine from 2007 to 2016 were retrospectively analyzed. Total survival and prognostic risk factors. Sex, age of onset of breast cancer, time of menopause, mode of breast cancer operation, pathological results of primary breast cancer, estrogen receptor, progesterone receptor Cerb-2, primary axillary lymph node metastasis were recorded in detail. The diagnosis of liver metastasis was accompanied by metastasis of other parts, adjuvant treatment of breast cancer after operation, time of diagnosis of liver metastasis, the first time of RFA treatment and the condition of adjuvant treatment after RFA treatment. There was no progressive survival time, total survival time, family history after RFA-induced liver metastasis, total survival time, family history, total survival time, and family history. A fertility history, etc. To analyze the effect of these clinical features on progressive survival after radiofrequency ablation. The statistical analysis was performed by Kaplan-Meier method and log-rank test. The result is 1: 1. All the 22 patients were female. The median age of onset was 46 years old and 28-65 years old. The PFS time of all cases was 2.3-93.2 months, and the median PFS time was 11.8 卤3.6 months. The survival time of all cases was 2.7-93.2 months after RFA, and the median survival time was 23.8 卤5.8 months and 95% CI: 12.5-35.2%. The survival time after liver metastasis was 10.8-98.5 months, and the median survival time was 38.9 卤3.6 months. The primary axillary lymph node metastasis, liver metastasis was single or multiple focus, the time interval between the first diagnosis of liver metastasis after operation of breast cancer, the time interval of initial RFA treatment after the diagnosis of liver metastasis was correlated with PFS after RFA. However, there was no significant difference (P 0.05). 4. It was not proved that the age of breast cancer onset, the postmenopausal ER status and PR status Her-2 status of breast cancer, the single or multiple hepatic metastases, and whether the liver metastases were associated with other metastases were significantly correlated with PFS. Conclusion 1. The axillary lymph node stage, the interval between the first diagnosis of liver metastasis after operation and the interval between the first time of RFA treatment after the diagnosis of liver metastasis had influence on the PFS after RFA treatment. The earlier the liver metastasis was found after breast cancer operation, the earlier the liver metastasis was found. The earlier the diagnosis of liver metastasis is, the better the prognosis is. In this study, the progression-free survival time (11. 8 months) after RFA was similar to that reported in the literature (November). The total survival time (38.9 months) was higher than that in TACE's operation (26 months), similar to that of hepatectomy at 20-67 months. Patients with liver metastasis from breast cancer can benefit from RFA.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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