Clinical Studies Of Bone Metastasis Of Breast And Endocrine Therapy

By analyzing clinical data accumulated over years, we conducted this retrospective study to achieve the following goals: 1) to ascertain the clinical regularity of bone metastasis in patients with breast cancer; 2) to compare the efficacy of endocrine therapy and chemotherapy in non-visceral metastasis patients; 3) to analyze the relevant factors associated with endocrine therapy in metastatic breast cancer (MBC), and ultimately provide reasonable evidence-based medical verification for treatment of MBC.In first part of this study, we found the most common sites of bone metastases were lumber thoracic vertebra . pelvis . rib and femur, almost all of the bone metastases tended to be osteolytic. The median time of bone metastasis was 33 months after the surgical procedure, which ranged from 0 to 15 years. There was a higher hormone receptor-positive proportion in patients with bone metastasis, and the prognosis of those patients was better than visceral metastasis ones.In second part, we compared the efficacy of two systemic therapies in bone metastasis patients without viscera involved. The efficacy of first-line endocrine and chemotherapy for breast cancer patients with bone metastasis were 35.4% and 31.7%, respectively. (P=0.687), whereas the second-line efficacy were 23.9% and 24.2% (=0.973), the overall response rate were 27.1% and 25.0%(P=0.690). The CBR of first-line endocrine and chemotherapy in these patients were 43.9% and 36.6%(P=0.437), whereas the CBR of second-line treatment were 47.8% and 24.2% (P=0.033), and the CBR of all treatments were 47.5% and 27.7% (P=0.001), respectively, these differences were all significant. The mean TTF of the endocrine and chemotherapy arm were 5 months and 2 months (P<0.001),whereas the mean TTP were 5 months and 2.5 months (P<.001) in clinical control patients, the differences were all significant. We concluded that endocrine therapy alone is superior to chemotherapy alone in non-visceral metastasis patients.In the third part of the study, Analysis of the patient who identified by ER, PgR and HER-2 , demonstrated that the response rate of first-line and heavily treated endocrine therapy were 33.3% and 14.1% (P=0.003) ; the response rate for anti-estrogens, progesterone and aromatase inhibitors in first-line therapy were O. 25% and 39.5% (.P=0.038); the response rate of soft tissue metastasis, bone metastasis and viscera metastasis were 21.5%, 20.2% and 9.3% (P=0.020) ,which show that comparing with viscera metastatic patients, those with soft tissue and bone metastasis alone have a relative good clinical outcome , therefore, endocrine therapy is suitable for this kind of patients; The response rate of endocrine therapy in estrogen receptor -positive and negative group were 22.6% and 3.3% (P=0.015), so ER is an predictive factor of endocrine therapy, whereas the predictive role of PgR status and HER-2 is uncertain.