54例乳腺癌术后胸壁转移患者的临床特征及预后因素分析

目的：探讨乳腺癌术后局部胸壁转移患者的临床特征、治疗方式及影响预后的因素。方法收集54例术后以胸壁复发为首发转移部位的乳腺癌患者的临床资料,分析各项临床和病理因素同局部控制率及生存期之间的关系;并搜索万方及Pubmed数据库中的相关文献,进行汇总分析。结果54例患者原发肿瘤术后无病生存期（DFS）为4～277个月,中位DFS为50个月。单纯胸壁转移患者局部复发后无进展生存期（PFS）2～120个月,中位PFS为21个月。单纯胸壁转移组的单因素分析结果显示患者的原发肿瘤病理类型、脉管癌栓情况、激素受体水平、HER2表达情况是原发肿瘤术后DFS及OS的相关预后因素;多因素分析结果显示原发肿瘤的病理类型、脉管癌栓情况、术后辅助放疗、辅助内分泌治疗及原发肿瘤术后DFS是总生存期的独立预后因素。结论乳腺癌术后局部复发将增加远处转移及死亡风险,明确高复发风险因素,采取全身综合治疗及局部治疗可改善患者预后。     

乳腺癌患者术后胸壁复发及预后相关因素分析

目的 乳腺癌出现胸壁复发通常被认为是乳腺癌治疗失败的第一征象,是发生远处转移的先兆.本研究回顾性分析乳腺癌术后胸壁复发患者病例资料,分析影响乳腺癌患者术后胸壁复发及预后的相关因素,为规范的临床治疗提供有用的依据.方法 收集湖南省肿瘤医院2008-01-01-2009 12-31收治的130例乳腺癌术后胸壁复发患者的临床、病理及预后资料,其中Ⅰ期42例,Ⅱ期60例,Ⅲ期28例,分析其临床特点和胸壁复发时间,Kaplan-Meier法计算患者无瘤生存率,采用二元Logistic回归分析复发的影响因素,OR及95％ CI为评价指标,采用Cox回归分析生存期的影响因素,HR及95％CI为评价指标.结果 3、5年无瘤生存率分别为58.4％和33.7％,3、5年总体生存率为91.4％和83.9％,中位发病年龄为45岁,中位复发时间为25个月,中位生存时间为56个月.胸壁复发二元Logistic回归分析显示,肿瘤分期、肿瘤大小及细胞分化程度、雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)和Ki-67表达、淋巴结转移是影响乳腺癌患者术后胸壁复发的相关因素,均P＜o.05. Cox分析显示,肿瘤分期、肿瘤细胞分化程度、肿瘤病理类型及C-erbB-2表达是影响患者5年总体生存率的因素,均P＜0.05.结论 肿瘤分期晚、肿瘤偏大,肿瘤细胞分化程度低、存在4枚及以上腋窝淋巴结转移、ER和PR低表达及Ki-67高表达是乳腺癌术后胸壁复发的危险因素,而临床分期Ⅲ期、肿瘤细胞低分化、肿瘤病理类型为浸润型癌、C-erbB-2阳性表达是总生存的独立预后因素,对存在上述危险因素的患者,应根据患者情况选择个体化的综合治疗方案,加强随访改善患者预后.     

73例乳腺癌术后胸壁复发因素及预后分析

目的：探讨乳腺癌术后胸壁局部复发因素及预后意义。方法：对73例乳腺癌术后胸壁复发患者进行回顾性分析。结果：本组患者占同期全部乳腺癌病例的4．02％，其中50例(68．5％)胸壁复发发生在术后2年内，复发后34例(46．6％)于2年内死亡。结论：乳腺癌原发肿瘤分期晚、腋下淋巴结癌转移数多、复发率高；原发灶雌激素受体(ER)及孕激素受体(PR)阴性患者．复发多出现在术后2年内。术后胸壁复发时，复发病灶情况及治疗效果是影响预后的因素之一，以手术为主的综合治疗可提高其远期疗效。     

33例外周原始神经外胚瘤临床分析

目的:探讨各种临床因素及治疗方法对外周原始神经外胚瘤(pPNET)预后的影响.方法:回顾性分析天津医科大学附属肿瘤医院2001年1月至2009年11月间收治的33例病理诊断为pPNET患者的临床资料,其中:男15例,女18例;中位年龄17岁;肿瘤原发于躯干部位21例,非躯干部位12例(10例原发于四肢,2例原发于头皮).25例患者接受了手术治疗,其中19例接受根治性手术,6例接受姑息性手术,8例根治术后患者及1例姑息术后患者接受了术后放疗;8例未手术患者中3例接受了局部放疗.手术治疗病例中17例接受了术后化疗,5例接受了术前化疗;未手术病例中5例接受了全身化疗.采用Kaplan-Meier法及Cox回归模型分析影响生存的因素,组间比较采用χ2检验.结果:全组中位生存期为24个月(范围10～38个月),2年生存率为36.4%;根治术后局部复发率为31.6%;全组主要转移部位为肺和骨,转移率均为24.2%.单因素分析显示肿瘤原发部位(P=0.005)、手术方式(P=0.001)可以影响全组患者的总生存期,术后放疗(P=0.039)有可能提高术后患者的生存期;多因素分析显示肿瘤原发部位(P=0.037)、手术方式(P=0.017)是影响患者生存的独立预后因素.结论:pPNET临床上恶性程度高,预后差,肿瘤原发部位、手术方式可以影响pPNET患者的总生存期,术后放疗有可能提高术后患者的生存期,肿瘤原发部位及手术方式是影响患者生存的独立预后因素.     

88例早期乳腺癌术后胸壁复发的多因素分析

目的 探讨影响早期乳腺癌根治术和改良根治术后胸壁复发及其预后的相关因素.方法 对本院1995～2005年收治的88例早期乳腺癌术后胸壁复发患者进行回顾性分析.其中Ⅰ期12例,Ⅱa期33例,Ⅱb期43例（不包括T3N0M0和T1N1M0、T2N1M0中淋巴结阳性4个以上者）,术后均未接受胸壁放疗,复发后均采用以局部放疗和全身化疗为主的综合治疗.结果 中位发病年龄为47岁,中位复发年龄为49岁,中位复发时间为24个月,中位生存时间为59.5个月.总的5、10年生存率为85.5%、44.9%.3、5年无瘤生存率为36.6%、21.2%.复发后的3、5年生存率为59.6%、41.8%.行根治术者胸壁复发时间显著长于行改良根治术者（P＜0.002）;术后行化疗者胸壁复发时间显著长于术后未行化疗者（P＜0.002）;术后行内分泌治疗者胸壁复发时间显著长于术后未行内分泌治疗者（P＜0.032）.单纯胸壁复发者生存率显著高于伴有区域性淋巴结转移或远处转移者（P＜0.02）;2年以上复发者生存率显著高于2年以内复发者（P＜0.003）;ER（＋）者生存率显著高于ER（-）者（P＜0.026）.结论 手术方式、术后有无全身化疗及内分泌治疗是影响早期乳腺癌术后胸壁复发的相关因素.术后胸壁复发时间、有无出现区域性淋巴结转移或远处转移、ER表达情况等是影响早期乳腺癌胸壁复发后预后的相关因素.     

73例乳腺癌术后胸壁复发因素及预后分析

目的:探讨乳腺癌术后胸壁局部复发因素及预后意义.方法:对73例乳腺癌术后胸壁复发患者进行回顾性分析.结果:本组患者占同期全部乳腺癌病例的4.02%,其中50例(68.5%)胸壁复发发生在术后2年内,复发后34例(46.6%)于2年内死亡.结论:乳腺癌原发肿瘤分期晚、腋下淋巴结癌转移数多、复发率高;原发灶雌激素受体(ER)及孕激素受体(PR)阴性患者,复发多出现在术后2年内.术后胸壁复发时,复发病灶情况及治疗效果是影响预后的因素之一,以手术为主的综合治疗可提高其远期疗效.     

21例乳腺癌术后孤立性肺转移的临床分析及预后

目的:探讨乳腺癌术后孤立肺转移的临床病理特点、治疗方法及预后因素。方法:自1999年1 月～2009年1 月,中国医学科学院肿瘤医院对35例乳腺癌术后孤立肺结节患者进行了手术治疗,对上述患者的临床特点、治疗方式、生存期及预后因素进行了单因素和多因素的分析。结果:乳腺癌手术至发现肺结节的时间为6～177 个月,中位时间48个月。经病理证实,乳腺癌肺转移21例（60.0%）,原发性肺癌8 例（22.9%）,良性病变6 例（17.1%）。 乳腺癌肺转移患者中,术后2、3、5 年的生存率分别为95.2%（20/21）、71.4%（15/21）、19.0%（4/21）。 从肺转移切除术至再次出现病情进展的中位时间（PFS）为32个月（3～73个月）;全组患者生存期为12～103 个月,中位时间43个月。经过单因素分析,影响乳腺癌肺转移术后至病情再次进展（PFS）的因素包括乳腺癌原发肿瘤大小、有无脉管瘤栓以及肺转移术后是否接受化疗（P<0.05）;而原发肿瘤至肺转移的时间（无瘤生存期,DFS）以及肺转移术后是否化疗与肺转移术后生存期（OS）有关（P<0.05）。 但经过多因素分析,上述因素对PFS 无显著关系。结论:乳腺癌术后孤立肺结节的外科治疗具有诊断和治疗的作用,术后全身治疗对提高无进展生存及总生存可能有一定的积极意义。      

乳腺癌根治术后单纯胸壁复发放疗和胸壁再复发的预后分析

目的 探究乳腺癌根治术后单纯胸壁复发(ICWR)患者的照射野及剂量选择,同时分析胸壁再复发的预后因素。方法 回顾性分析1998—2018年间解放军总医院第五医学中心和医科院肿瘤医院收治的乳腺癌改良根治术后ICWR患者 201例,患者术后均未行辅助放疗。胸壁复发后 48例(73.6%)患者接受手术治疗,155例(77.1%)患者接受放疗。无进展生存(PFS)率的计算采用Kaplan-Meier法和log-rank检验,多因素分析采用Cox回归法。胸壁再复发的计算采用竞争风险模型和Gray检验,多因素分析采用F&G回归法。结果 复发后中位随访时间92.8个月,5年PFS率为23.2%,5年胸壁再复发率为35.7%。多因素分析显示联合手术+放疗和复发间隔时间>12个月患者有较低的胸壁再复发率,复发间隔时间>48个月、联合局部+全身治疗及联合手术+放疗的患者有较高PFS率。155例患者ICWR后接受胸壁放疗,全胸壁照射+局部补量比全胸壁照射可以改善首次胸壁复发后的 5年PFS率(34.0%∶15.4%,P=0.004)。胸壁放疗剂量(≤60Gy∶>60Gy)对胸壁再复发率及PFS率无明显影响(P>0.05)。53例未手术患者胸壁瘤床剂量≤60Gy和>60Gy的 5年PFS率分别为9.1%和20.5%(P=0.061)。结论 乳腺癌根治术后ICWR患者局部放疗建议包括全胸壁照射+局部补量,复发灶剂量需加至60Gy,对未行手术切除者需>60Gy。ICWR患者仍有较高的胸壁再复发风险,需要探索更有效的治疗方法。     

48例复发性肝细胞癌再次切除术后的疗效及预后因素分析

目的:分析复发性肝细胞癌行再次切除术后的疗效和影响预后的因素。方法:回顾性分析中山大学附属肿瘤医院和江西省人民医院1995年7 月至2003年7 月48例复发性肝细胞癌患者行再次肝切除术的临床病理资料,包括患者性别、年龄、原发肿瘤和复发肿瘤的病理学特征、再次肝切除术前全身状况、复发的出现时间及生存期等,根据随访结果计算总生存率和无瘤生存率,并作单因素及多因素分析。结果:48例患者再次切除术后中位生存时间36.3 个月,1、3、5 年累积生存率分别为81.3% 、45.8% 、27.1% ,1、3、5 年无瘤生存率分别为70.8% 、25.0% 、16.7% 。单因素分析结果显示:原发肿瘤TNM分期、原发肿瘤伴血管侵犯、复发间隔时间、复发肿瘤大小、复发肿瘤TNM分期、复发肿瘤伴血管侵犯影响再切除术后累积生存率;复发间隔时间、原发肿瘤TNM分期、复发肿瘤大小、复发肿瘤有无血管侵犯、复发肿瘤病理分级和AFP 水平影响再切除术后无瘤生存率。多因素分析显示:复发间隔时间、复发肿瘤TNM分期是影响复发性肝癌再切除术后累积生存的独立危险因素;复发间隔时间、复发肿瘤大小是影响其无瘤生存的独立危险因素。结论:肝内复发间隔时间短（≤24个月）、复发肿瘤直径>5cm、复发肿瘤TNM分期越晚,提示再次切除术后预后不良。      

脊柱转移性肿瘤患者术后生存期的影响因素分析

目的 分析脊柱转移性肿瘤患者术后生存期的影响因素。方法 回顾性选取68例脊柱转移性肿瘤患者，所有患者均行外科手术治疗。术后随访2年，统计患者生存、死亡情况，并据此分为死亡组和生存组。收集患者一般临床资料，单因素及多因素Logistic分析脊柱转移性肿瘤患者术后生存期的影响因素。结果 2组年龄、性别、吸烟、体重指数(BMI)、原发肿瘤、合并基础疾病、累及椎体数、术中出血量比较，差异无统计学意义(P>0.05);死亡组原发肿瘤进展迅速、原发肿瘤低分化、内脏转移、转移时间<20个月、术后无局部放疗患者比率高于生存组，差异有统计学意义(P<0.05);多因素Logistic回归分析显示，原发肿瘤进展迅速、原发肿瘤低分化、内脏转移、转移时间<20个月、术后无局部放疗均是影响脊柱转移性肿瘤患者术后生存期的独立危险因素。结论 原发肿瘤进展迅速、原发肿瘤低分化、内脏转移、转移时间<20个月、术后无局部放疗均是影响脊柱转移性肿瘤患者术后生存期的独立危险因素，临床应加强对上述高危因素识别，并采取针对性预防措施。     

Reirradiation for locally recurrent lung cancer previously treated with radiation therapy

PURPOSE: Local recurrence of lung cancer after previous external beam irradiation poses some problems for subsequent management. We retrospectively reviewed our series of patients with local recurrence of lung cancer to evaluate the efficacy and safety of reirradiation. PATIENTS AND METHODS: Between 1979 and 2000, 34 patients with local recurrence of lung cancer were retreated with external radiation. There were 29 males and 5 females ranging in age from 38 to 85 years (median: 69 years). At the time of reirradiation, the clinical stage was I or II in 2 patients, IIIa in 5 patients, IIIb in 14 patients, and IV in 13 patients. Reirradiation was performed in 18 patients with the aim of achieving a cure or prolongation of survival (radical treatment), while 16 patients were treated for improvement of their symptoms (symptomatic treatment). RESULTS: The median interval between the initial radiation therapy and reirradiation was 23 months, with a range of 5 to 87 months. The dose of initial irradiation delivered to the tumor ranged from 30 to 80 Gy (median: 60 Gy) in 1.5--2.0-Gy fractions per day. During reirradiation, it ranged from 10 to 70 Gy (median: 50 Gy) in 1.8--3.0-Gy fractions per day. The cumulative dose delivered to the tumor by treatments of both initial and second irradiation ranged from 56.5 to 150 Gy (median: 110 Gy). A response was observed in 14 out of 18 patients given radical treatment (complete response, 6; partial response, 8). Twelve of the 16 patients (75%) given symptomatic treatment also showed a symptomatic benefit. The overall survival rate after reirradiation was 43% at 1 year and 27% at 2 years, with a median survival time of 8 months. The median survival time after radical treatment was 15 months, with a range of 3 to 58 months, whereas that after symptomatic treatment was 3 months, with a range of 1 to 14 months. Six long-term survivors lived for more than 20 months. Reirradiation-induced toxicity included symptomatic radiation pneumonitis in 19 patients and symptomatic radiation esophagitis in 6 patients. These toxicities were not fatal, and radiation myelopathy was not caused by reirradiation. CONCLUSION: Based on this study, external beam reirradiation can achieve satisfactory results for local recurrence of lung cancer provided that attention is paid to the possible hazards.     

35例颅内血管外皮细胞瘤预后的临床分析

目的:探讨总结中枢神经系统血管外皮细胞瘤（HPCs）临床治疗效果和预后。方法:回顾性分析35例HPCs的病例资料,均在显微镜下完成手术治疗,通过统计学方法分析影响其预后的关键因素。结果:所有患者确诊HPC后平均存活时间是82.4个月,1年,5年,10年总存活率分别为100%,93.8%和72.4%。13例（37.1%）患者首次手术后肿瘤复发。复发的平均时间是65.4个月,1年,5年,10年肿瘤无进展生存率分别为99%,49%,31%。3例患者发生颅外转移。患者接受任何形式的放射治疗与未接受放射治疗的患者相比,均没有延长总存活时间（P=0.22）,但延长了肿瘤无进展生存时间（P=0.04）。肿瘤直径≥6 cm和肿瘤侵犯静脉窦的患者比肿瘤直径<6 cm 和未侵犯静脉窦的复发更早（P<0.05）。结论:手术切除联合放疗可以阻止肿瘤进展,但不能延长患者总存活率。最大程度的肿瘤切除可以提高患者总存活率（P<0.05）。间变型HPC患者总存活率低,肿瘤无进展生存时间短（P<0.05）。     

The use of radiotherapy for treatment of isolated locoregional recurrence of breast carcinoma after mastectomy

The role of radiotherapy in the treatment of isolated local recurrence of breast cancer after mastectomy is controversial. In an attempt to define this role, the results of moderate-dose radiotherapy in 90 such patients were reviewed. The median follow-up time for these patients was 81 months. The actuarial probability of local control after treatment was 42% at 5 years and 35% at 10 years. Freedom from distant failure was 30% at 5 years and only 7% at 10 years. The rate of appearance of distant metastasis was fairly constant at approximately 20% of patients per year. Overall survival was 50% at 5 years and 26% at 10 years. Overall survival and relapse-free survival were both chiefly influenced by the disease-free interval (DFI). Patients who presented with a DFI of greater than or equal to 2 years had a 5-year actuarial overall survival rate of 58% compared to 33% for patients with a DFI of less than 2 years (P = 0.04). Subsequent local failures after radiotherapy were principally seen at the initial site of recurrence, but also at other sites in or at the edge of the radiation fields. These results strongly suggest that patients with apparently isolated local recurrence after mastectomy are incurable by further local treatment. Effective systemic therapy is required to improve the results in these patients. Radiotherapy is a useful palliative procedure in patients with long disease-free intervals. The role of radiotherapy in conjunction with systemic therapy is, as yet, undefined.     

Prognosis following local recurrence in the conservatively treated breast cancer patient

At Yale-New Haven Hospital conservative treatment of early stage breast carcinoma with lumpectomy and radiation therapy has been used with increasing frequency since the 1960s. We have reviewed our experience with specific reference to prognosis following local recurrence. Between January 1962 and December 1984 a total of 433 patients were treated with conservative surgery and radiation therapy using standard techniques. As of December 1989, with minimum evaluable follow-up of 5 years and a median follow-up of 8.21 years, there have been a total of 50 ipsilateral breast recurrences resulting in a 5-year actuarial breast recurrence rate of 8%. Extent of disease at the time of local recurrence was clinically categorized as localized (less than 3 cm without dermal involvement) or diffuse (greater than 3 cm and/or with dermal involvement). Seventy-two percent of the recurrences were at or near the original tumor site whereas 28% recurred elsewhere in the breast. At a median follow-up post recurrence of 5.0 years (range 0.3-16.9 years), the 5-year actuarial survival for breast recurrences was 59% and the 5-year disease-free survival was 65%. A number of clinical and pathological features at the time of original diagnosis as well as at the time of local recurrence were tested as possible prognostic indicators for survival following local recurrence. By univariate analysis, significant factors associated with survival following local recurrence included extent of local disease at the time of recurrence (p less than .01), time to local recurrence (p less than .03), with later recurrences doing better, and site of local recurrence (p less than .01), with recurrences elsewhere in the breast doing better. We conclude from this large single institutional experience with a median follow-up post-recurrence of over 5 years that patients experiencing a local recurrence in the conservatively treated breast have a relatively favorable prognosis. The prognostic factors correlating with survival and implications regarding adjuvant systemic therapy at the time of local recurrence are discussed.     

Local-regional failure in patients treated with adjuvant chemotherapy for breast cancer

Risk factors for local-regional recurrence of breast cancer were analyzed in a retrospective review of 117 patients treated with adjuvant CMF (Cytoxan [Mead Johnson & Co, Evansville, Ind], methotrexate, 5-fluorouracil) after radical or modified radical mastectomy at the Vincent T. Lombardi Comprehensive Cancer Center (Washington, DC). The median follow-up time was 50 months after mastectomy. The median time to recurrence was 23 months. The actuarial local-regional failure rate was 19% at five years. Risk of local failure correlated with size of primary (27% for T3 v 15% for T1) and axillary node status (36% for four or more positive nodes v 9% for three or fewer positive nodes). These findings suggest a rationale for the addition of postoperative radiation therapy in high-risk patients treated with adjuvant chemotherapy.     

食管癌根治性治疗后局部复发患者的预后因素分析

目的 探讨食管癌根治性治疗后局部复发患者多学科综合治疗的疗效及预后因素.方法 回顾性分析196例食管癌根治性治疗后局部复发患者的临床特点,并结合随访资料进行预后因素分析.采用Kaplan-Meier法和Log rank法比较生存率,以Cox模型进行多因素回归分析.结果 全组患者的中位生存时间为8.0个月,1、2、3年生存率分别为29.8％、5.9％和4.0％.单因素分析结果显示,复发时PS评分、首次根治性治疗后与复发的间隔时间、首次治疗方案以及复发后的治疗方案与患者的预后相关.Cox多因素回归分析的结果显示,首次治疗方案和复发后治疗方案为独立预后因素.复发后采用放化疗联合治疗、单纯放疗、单纯化疗、分子靶向治疗和对症支持治疗患者的中位生存时间分别为13.0、7.0、6.0、4.0和3.0个月(P=0.000).93例既往未曾接受过放疗而复发后行放射治疗的患者中,放疗剂量≥60 Gy者的生存时间明显长于放疗剂量＜60Gy者(P =0.000).结论 首次治疗方案和复发后治疗方案为食管癌根治性治疗后复发的独立预后因素,建议对复发患者予以积极的多学科综合治疗以进一步提高疗效.对于局部复发既往未曾接受过放疗的患者,放疗剂量应该≥60Gy.食管癌根治性治疗后复发者的预后差,有必要对其他的治疗方法(如手术、靶向治疗等)做进一步探索.     

晚期三阴性乳腺癌的临床特征及生存分析

目的 分析晚期三阴性乳腺癌(TNBC)的临床特征,探讨影响其预后的因素.方法 收集1999年1月至2007年12月间134例晚期TNBC患者的临床资料,回顾性研究其临床特点、生存状况及预后因素.结果 134例患者确诊为晚期TNBC的中位年龄为45岁.6例为初治Ⅳ期,128例为初治Ⅰ一Ⅲ期,经手术等治疗后出现局部复发或远处转移.14例为局部复发及区域淋巴结转移,75例为远处转移,45例患者为同时出现局部复发及远处转移.最常见的远处转移部位是肺,其中51.7%(62/120)的患者同时出现2个部位以上的转移.随访至2009年6月30日,死亡75例(56.0%).全组患者的中位总生存时间(OS)为26.5个月(95%C/为20.5～32.6个月),1、3、5年预期总生存率分别为80.9%、37.1%和30.1%.初诊转移部位为单发骨转移患者预后好,7例患者的中位OS为84.2个月.111例晚期接受一线方案化疗的患者中位OS为28.5个月,23例未接受化疗的患者中位OS为12.6个月,差异有统计学意义(P=0.0001).一线化疗有效(完全缓解+部分缓解)患者45例,疾病稳定患者39例,疾病进展患者12例.化疗有效患者的中位OS为36.1个月,明显高于疾病稳定患者(20.8个月)和进展患者(14.0个月),差异有统计学意义(P=0.0108).单因素预后分析结果显示,是否远处转移、复发转移后是否接受化疗以及一线化疗疗效对患者的5年OS有显著影响(P<0.05).Cox比例风险模型分析结果显示,是否接受一线化疗以及一线化疗疗效是影响晚期TNBC预后的独立因素.结论,TNBC易早期出现局部复发和远处转移,且内脏转移及多部位转移的比率较高,可能与其侵袭性高和缺乏有效的治疗手段有关.晚期TNBC患者预后较差,化疗能够改善其预后.

Abstract：

Objective To characterize the sites of distant recurrence and clinical outcomes in a cohort of Chinese patients with metastatic triple-negative breast cancer (TNBC ). Methods One hundred and thirty-four patients with metastatic TNBC treated at Cancer Hospital of CAMS from January 1999 to December 2007 were included in this study. Hie clinicopathological features and long-term survival of the patients were retrospectively analyzed. Results The median age of the patients was 45 years. Most patients (72.7% ) had a higher predilection for visceral metastasis and early recurrence within the first two years of follow-up. Six patients (4.5%) presented with stage Ⅳ disease, 14 patients were diagnosed with locoregional recurrence after mastectomy, 75 patients with distant metastases, and 45 patients with both locoregional recurrence and distant metastasis. The most common site of first recurrence was the lung, and 62(51.7% )of the patients had more than two sites of metastasis. By July 30, 2009, 75 patients died of breast cancer (56.0%). The median overall survival (OS) was 26. 5 months [95% confidence interval (CI), 20. 5-32. 6 months]. The l-,3- and 5-year overall survivals ( OS) were 80. 9% ,37. 1% and 30.1% , respectively. The median overall survival time of 58 patients with single site of metastasis was 28.5 months, longer than that of patients with more than two sites of metastases. Patients whose initial distant recurrence was bone metastasis only (7 patients) had better prognosis, with a median OS of 84.2 months. The median OS (28.5 vs. 12.6 months, P =0.0001) differed significantly between patients who received first-line chemotherapy and those who did not. Forty-five of the 96 patients with measurable disease achieved complete/partial response (CR/PR), 39 patients had stable disease (SD), and 12 patients had disease progression (PD). The median OS was 36.1 months in patients with CR/PR, 20. 8 months with SD, and 14 months with PD, respectively. The median OS of patients with CR/PR was significantly longer than that of patients with SD/PD (P =0. 0106). Distant metastasis, first-line chemotherapy and clinical response were significantly related with OS by univariate analysis. Furthermore, first-line chemotherapy and the clinical response were demonstrated to be an independent prognostic factor by multivariate analysis. Conclusions Recurrence risk and mortality are considerably higher in TNBC patients within the early years of follow-up. TNBC patients have a higher risk of multiple and visceral metastases, and poorer survival, which might attribute to its aggressive clinical behavior and lack of effective regimens. Our findings also suggest that chemotherapy can effectively improve the clinical outcome of those patients.     

Short time to recurrence after hepatic resection correlates with poor prognosis in colorectal hepatic metastasis

BACKGROUND: Early recurrence is a major problem after hepatic resection of colorectal hepatic metastasis (CHM). Our aim was to investigate the relationship between time to recurrence after CHM resection and overall survival. METHODS: A retrospective analysis was performed for 101 consecutive patients who underwent hepatic resection for CHM and have been followed more than 5 years. RESULTS: Among 101 patients, 82 (81%) had a recurrence. Overall survival of patients with recurrence within 6 months after CHM resection was significantly worse than that of patients with recurrence after more than 6 months (P < 0.01). Overall survival was poorer when time to recurrence was shorter. One of the reasons for poor prognosis of patients with recurrence within 6 months was that only a few patients could undergo a second resection for recurrence after CHM resection. Histological type, including poorly differentiated signet ring cell or mucinous adenocarcinoma in the primary tumor, bilobar metastases, microscopic positive surgical margin and carcinoembryonic antigen (CEA) above 15 ng/ml had predictive value for decreased recurrence-free survival after CHM resection. CONCLUSION: Short time to recurrence after CHM resection correlates with a poor prognosis. Histological type of poorly differentiated signet ring cell or mucinous adenocarcinoma in the primary tumor might be a predictor for early recurrence after CHM resection.