本文選題：乳腺癌 + 肝轉移　； 參考：《浙江大學》2017年碩士論文

【摘要】：背景:乳腺癌是女性最常見的一種惡性腫瘤,每個女性一生中患乳腺癌的風險約有10%,大約20%的患者會經(jīng)歷局部復發(fā)或遠處轉移。在過去的數(shù)十年間,輔助治療明顯的改善了原發(fā)性乳腺癌患者的生存率。但是乳腺癌肝轉移病人的預后依然很差。肝臟切除術以及局部消融術在結直腸癌肝轉移患者中已經(jīng)是公認的安全有效的療法,這些技術對乳腺癌肝轉移患者是否有效也成為了大家所關注的問題。本研究中就2007年到2016年在浙江大學醫(yī)學院附屬第二醫(yī)院接受射頻消融治療的22例乳腺癌肝轉移患者的臨床特征及無進展生存期和總生存期進行分析,找到對于乳腺癌肝轉移患者射頻消融術后無進展生存期有影響的因素,并借此預估患者預后。資料與方法:回顧性分析了 2007年到2016年在浙江大學醫(yī)學院附屬第二醫(yī)院接受射頻消融治療的具有詳細病歷資料及隨訪資料的22例乳腺癌肝轉移患者臨床特征、無進展生存期、總生存期及預后相關危險因素。詳細記錄了患者的性別、乳腺癌發(fā)病年齡、絕經(jīng)時間、乳腺癌手術方式、乳腺癌原發(fā)灶病理結果、雌激素受體、孕激素受體、Cerb-2情況、原發(fā)灶腋窩淋巴結轉移情況、確診肝轉移時合并其他部位轉移情況、乳腺癌術后輔助治療情況、確診肝轉移時間、初次行RFA治療時間、RFA治療后的輔助治療情況、RFA術后無進展生存時間、總生存期、家族史、生育史等。分析這些臨床特征對患者射頻消融術后無進展生存期的影響。統(tǒng)計分析采用 Kaplan-Meier 法、log-rank 檢驗。結果:1.全組22例患者均為女性,中位發(fā)病年齡為46歲(28-65歲)。所有病例PFS時間為 2.3-93.2 月,中位 PFS 時間為 11.8±3.6 月(95%CI:4.7-18.9)。2.所有病例RFA術后生存時間為2.7-93.2月,中位生存時間為23.8±5.8月(95%CI:12.5-35.2)。確診肝轉移后生存時間為10.8-98.5月,中位生存時間為38.9±3.6 月(95%CI:36.8-46.1)。3.原發(fā)灶腋窩淋巴結轉移情況、肝轉移灶為單發(fā)灶或多發(fā)灶、乳腺癌手術后初次確診肝轉移的時間間隔、確診肝轉移后初次行RFA治療的時間間隔與RFA術后PFS有相關性,但無顯著性差異(P0.05)。4.未能證明乳腺癌發(fā)病年齡、乳腺癌發(fā)病時絕經(jīng)狀態(tài)、ER狀態(tài)、PR狀態(tài)、Her-2狀態(tài)、肝轉移灶單發(fā)或多發(fā)情況、確診肝轉移時是否合并其他部位轉移等與PFS有顯著相關性。結論:1.腋窩淋巴結分期、乳腺癌手術后初次確診肝轉移的時間間隔、確診肝轉移后初次行RFA治療的時間間隔對RFA治療后的PFS有影響,乳腺癌手術后發(fā)現(xiàn)肝轉移越早、確診肝轉移后處理時間越早,預后越好;2.本研究中RFA術后無進展生存時間(11.8月)與文獻報道(11月)相似�？偵嫫�(38.9月)高于肝臟TACE術(26月),與肝臟切除術相似(20-67月)。3.乳腺癌肝轉移患者可以從RFA術中獲益。
[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 鹵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 鹵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 鹵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.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.9

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相關期刊論文 前1條

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本文編號：1795329