| Objective: To explore the recurrence group and its correlation with prognosis in postoperative patients with metastatic breast cancer,to determine the prognostic factors that affect the survival of postoperative metastatic patients,and to provide a clinical basis for individualized medical treatment of advanced breast cancer.Methods: A total of 160 women with metastatic breast cancer who received anti-tumor therapy from the Department of Oncology,First Affiliated Hospital of Dalian Medical University from January 2010 to December 2014 were collected and followed up until the end of December 2017.The patients were divided into four groups:HR+/HER-2-,HR+/HER-2+,HR-/HER-2+,HR-/HER-2-according to the postoperative HR and HER(Eleven patients were biopsied after transplanted.The coincidence rate of biopsy group and operation group was 82.0%).The clinical data of the following groups were collected respectively: surgery and recurrence age,T stage,N stage,clinical stage,histological grade,surgical to recurrence interval,adjuvant therapy,palliative regimen and sequence,first transfer site,the number of metastatic sites,palliative chemotherapy line.Chi-square test was used for comparisons between clinical groups.Survival analysis was performed by Kaplan-Meier method and survival curves were drawn to calculate the 1,2,3 year survival rates and median survival.Univariate analysis using Log-rank test,P < 0.05 were included in the COX model multivariate analysis,and ultimately determine the impact of postoperative survival of patients with metastatic breast cancer independent prognostic factors.Results: 160 patients were divided into four groups according to the immunohistochemical parameters of ER,PR and HER-2,the median survival of HR+/HER-2-group was 67.1 months,and the survival rates at 1,2 and 3 years were92.8%,88.0% and 74.7%,respectively.The median survival of HR +/HER-2+group was 41.5 months,and the survival rates at 1,2 and 3 years were 81.8%,63.6% and57.6%,respectively.The 39.4-month median survival time in HR-/HER-2+ group was75.0%,63.0% and 55.9% respectively.The median survival for the HR-/ HER-2-group was 38.0 months,with 1,2,and 3-year survival rates of 75.0%,62.5%,and 54.2%,respectively.Median survival and survival rates of the four groups were compared,the difference was statistically significant(P = 0.003,P<0.05).The HR+/ HER-2-group had the best prognosis and the HR-/HER-2-group had the worst prognosis.Only the age at first diagnosis,interval between operation and recurrence,adjuvant endocrine and adjuvant targeted therapy had significant difference between the four groups(P <0.05).Adjuvant or palliative endocrine therapy is routinely used in HR+patients and adjuvant targeted therapy is routinely used in HER-2+patients.Most of HR-/HER-2+patients underwent surgery at 50 years of age and older,more than half of patients relapsed within 2 years after surgery,while most patients of the other three groups underwent surgery less than 50 years of age and relapsed after 2 years.The median survival time of 160 patients was about 48.1 months.The survival rates at 1,2and 3 years were 85.6%,75.0% and 65.6%.Univariate analysis showed that there were no significant differences in age of surgery(<50 years,? 50 years),primary tumor characteristics(T stage,N stage,clinical stage,histological grade),adjuvant therapy(chemotherapy,radiotherapy,targeted therapy),relapse age(<50 years old,50-69 years old,> 69 years old),number of metastasis(1,? 2),palliative treatment(chemotherapy,targeted therapy),Palliative treatment order(chemotherapy--endocrine,endocrine--chemotherapy),chemotherapy line number(<3 line,?3 line)(P>0.05).There were significance differences in recurrence group based on HR and HER-2 status,the first transfer site(lung,liver,bone and brain),adjuvant and palliative endocrine therapy and time from surgery to recurrence interval(P < 0.05).People who showed HR+/HER-2-in primary tumors,relapsed more than two years after surgery,received adjuvant and palliative endocrine therapy,with the first transfer of the lungs had better prognosis.The univariate analysis of P<0.05 factors into the COX regression model,the results suggest that the first metastatic site of postoperative metastatic breast cancer patients is an independent factor affecting its prognosis,and the first metastatic site is lung with a better prognosis with a median survival of 60.3 months.Conclusion:1.It is reasonable to group according to the primary tumor surgery ER,PR and HER-2 status.Recurrence group has guiding significance for prognosis.2.HR and HER-2 status for relapse group were related to age of surgery,interval between surgery and recurrence,adjuvant endocrine and adjuvant targeted therapy,palliative endocrine therapy.3.Univariate analysis showed recurrence group,the time from operation to recurrence,the first metastatic site,adjuvant and palliative endocrine related to the prognosis after metastasis.4.Multiple factors showed that the first transfer site is an independent factor affecting the prognosis of postoperative metastatic patients,the first transfer of the lungs are good prognosis. |
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