Metastatic breast cancer patients with lung or liver metastases should be distinguished before being treated with fulvestrant
Metastatic breast cancer patients with lung or liver metastases should be distinguished before being treated with fulvestrant
复制标题
转移性乳腺癌患者在接受氟维司群治疗前应区分肺转移或肝转移
DOI：
10.1002/cam4.2453
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发表时间：
2019-08-02
期刊：
影响因子：
4
通讯作者：
Shao, Zhi-Ming
中科院分区：
文献类型：
--
作者：
He, Min;Li, Jun-Jie;Shao, Zhi-Ming
背景内分泌治疗是激素受体（HR）阳性转移性乳腺癌（MBC）患者的首选治疗方法。虽然内脏转移是一个负面的预后因素，但很少有研究区分不同内脏部位转移的患者的预后。患者和方法 总共分析了 6 年期间在单个中心接受 500 mg 氟维司群治疗的 398 名患者。使用逻辑回归模型来确定与无进展生存期（PFS）相关的预后因素。 Kaplan-Meier 分析用于比较肺转移和肝转移患者的 PFS。结果 233例患者基线存在内脏转移，其中肺（无肝）转移（无肝转移的肺转移）138例，肝（无肺）转移（无肺受累的肝转移）51例，肺和肝同时转移41例。中位 PFS 为 6.8 个月（内脏和非内脏转移分别为 5.6 和 9.2 个月，P = .028）。肺（无肝）转移患者的 PFS 比肝（无肺）转移或肺和肝转移患者更长（分别为 9.6、3.7 和 3.2 个月，P < 0.001；肝（无肺）与肺（无肝）激素受体 (HR) 1.70；肺和肝与肺（无肝）HR 2.85）。肝转移患者的 PFS 明显低于无肝转移患者（3.7 个月与 9.2 个月，P < .001）。在无病间隔较长、无肝转移且既往未接受化疗的患者中观察到 PFS 获益。结论 氟维司群治疗对肺（无肝）或非内脏转移患者有益。当采用内分泌治疗治疗HR阳性/HER2阴性MBC患者时，区分肺转移患者和肝转移患者非常重要。
Background Endocrine therapy is the preferred treatment for patients with hormone receptor (HR)-positive metastatic breast cancer (MBC). While visceral metastasis is a negative prognostic factor, few studies have distinguished between the prognoses of patients with metastases at different visceral sites. Patients and methods In total, 398 patients receiving fulvestrant 500 mg at a single center over a 6-year period were analyzed. Logistic regression models were used to identify the prognostic factors associated with progression-free survival (PFS). Kaplan-Meier analysis was used to compare the PFS of patients with lung and liver metastases. Results Baseline visceral metastases were present in 233 patients, including 138 with lung(w/o liver) metastases (lung metastases without liver involvement), 51 with liver(w/o lung) metastases (liver metastases without lung involvement) and 41 with lung and liver metastases. The median PFS was 6.8 months (5.6 and 9.2 months for visceral and nonvisceral metastases, respectively, P = .028). PFS was longer in patients with lung(w/o liver) metastases than in those with liver(w/o lung) metastases or lung and liver metastases (9.6, 3.7 and 3.2 months, respectively, P < .001; liver(w/o lung) vs. lung(w/o liver) hormone receptor (HR) 1.70; lung and liver vs. lung(w/o liver) HR 2.85). Patients with liver metastases experienced significantly worse PFS than those without liver involvement (3.7 vs. 9.2 months, P < .001). PFS benefits were observed in patients with longer disease-free intervals, no liver metastases, and no previous chemotherapy. Conclusion Fulvestrant treatment benefited patients with lung(w/o liver) or nonvisceral metastases. When treating HR-positive/HER2-negative MBC patients with endocrine therapy, it is important to differentiate patients with lung metastases from those with liver metastases.