| ObjectiveTo summarize the clinical characteristics of 191 patients with postoperative bone metastasis of breast cancer.The related factors affecting prognosis were analyzed and explored to provide guidance for early prevention,diagnosis and treatment of breast cancer patients with bone metastasis to ensure their quality of life.Materials and Methods191 patients with bone metastasis after breast cancer surgery in the First Affiliated Hospital of Zhengzhou University from October 2010 to October 2019 who met the inclusion criteria were retrospectively analyzed.Follow-up was conducted by telephone,in-patient examination and outpatient review and the deadline for follow-up was October 31,2021.Sorting out the data:the age at the diagnosis of breast cancer,the age at the diagnosis of bone metastases,menstrual status,primary tumor size,pathological type,lymph node metastasis status,estrogen receptor(ER)status,progesterone receptor(PR)status,human epidermal growth factor receptor 2(HER-2)expression,Ki67 expression,P53 status,CK5/6 status,E-Cadherin(E-Cad),site of bone metastasis,the number of bone metastasis,occurring time of bone metastasis,whether other metastases occurred and patient survival time.Chi-square test,Kaplan-Meier,Log-rank univariate survival analysis and Cox multivariate survival analysis were performed by SPSS21.0 software to summarize the clinical characteristics and identify the related prognostic factors.P<0.05 was statistically significant.Results1.The age of diagnosis of breast cancer ranged from 22 to 76 years with a median of 45 years old.The age of diagnosis of bone metastasis ranged from 22 to 82 years with a median of 47 years old.Premenopausal patients were 82 cases(42.9%)and postmenopausal patients were 109 cases(57.1%).The mass size of 111 cases was 2～5cm(58.1%),56 cases was ≤2cm(29.3%)and 24 cases was>5cm(12.6%).There were 154 patients(80.6%)with lymph node metastasis while 37 patients(19.4%)without lymph node metastasis.The invasive ductal carcinoma were 127 cases(66.5%),invasive lobular carcinoma were 60 cases(31.4%)and other types were 4 cases(2.1%).There were 150 cases of ER positive(78.5%),41 cases of ER negative(21.5%),127 patients(66.5%)of PR positive and 64 patients(33.5%)of PR negative.There were 132(69.1%)HER-2 positive patients and 59(30.9%)HER-2 negative patients.Ki-67 expression was low in 55 cases(28.8%)and high in 136 cases(71.2%).P53 was positive in 111 cases(58.1%)and negative in 80 cases(41.9%).CK5/6 positive patients were 54(28.3%)and negative patients were 117(71.7%).E-cad was positive in 150 cases(78.5%)and negative in 41 cases(21.5%).133(69.6%)cases were Luminal B types.30(15.7%)case were HER-2 positive types.18(9.4%)cases were Luminal A types and 10(5.2%)cases were triple-negative types.2.Among the 191 breast cancer patients with bone metastasis after surgery,38.7%developed bone metastasis within 1 year,71.8%accumulated bone metastasis within 3 years,87.4%accumulated bone metastasis within 5 years,and 12.6%developed bone metastasis after 5 years.The most lesions were distributed in the spine bone,accounting for 153 cases(80.1%),followed by 144 cases(75.4%)in the thoracic bone,91 cases in the pelvic bone(47.6%),56 cases in the limb bone(29.3%),and 32 cases(16.8%)in the skull.Chi-square test showed that the difference was statistically significant(χ2=18.391,P<0.05).131 cases(68.6%)had multiple bone metastases.60 cases(31.4%)had single bone metastases.52 cases(27.2%)had visceral metastases and 139(72.8%)had no visceral metastases.3.The survival time ranged from 7 to 86 months.At the end of the follow-up date,there were 128 cases died and 63 cases survived.The median survival time was 34 months.The 1-year survival rate was 92.1%and the 3-year survival rate was 50.3%and the 5-year survival rate was 36.1%.4.Univariate analysis showed that age at diagnosis of bone metastases(P=0.006),tumor size(P=0.007),ER status(P=0.045),P53 status(P=0.026),the number of bone metastases(P=0.004)and whether with viscera metastases(P=0.001)were all prognostic factors for breast cancer patients with bone metastases.But the age at diagnosis of breast cancer,pathological types,lymph node metastasis,PR status,HER-2 status,Ki67 expression level,CK5/6 and E-Cad expression status were not associated with prognosis(P>0.05).5.Multivariate analysis showed that age at the diagnosis of bone metastases,the number of bone metastases and whether with visceral metastasis were independent prognostic factors for breast cancer patients with bone metastases(P<0.05).Conclusion1.Breast cancer bone metastases mostly occur within 5 years after the diagnosis of breast cancer.The most common sites of bone metastases are spine followed by chest bone,pelvic bone,limb bone and skull.2.Age at diagnosis of bone metastases,tumor size,the status of ER and P53,the number of bone metastases and visceral metastases are all related factors for the prognosis of bone metastases.3.Age above 60 years old at diagnosis of bone metastases,multiple bone metastases and visceral metastases are independent risk factors for the prognosis of breast cancer patients with bone metastases. |
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