乳腺癌肝脏转移内科治疗专家片PPT课件

预后
Factors adversely affecting prognosis of breast cancer liver metastasis include: jaundice[1] deranged liver function tests[2] ascites, palpable hepatomegaly [3], poor performance status and disease confined to the liver[2,3]
概况 – 转移途径和临床症状
• 乳腺癌转移至肝脏的途径包括血行转移和淋巴转移，以血 行转移为主。血行转移包括经肝动脉转移，这种方式占血 行转移的58%-65%；经静脉系统转移；经淋巴道转移的 方式较少见。
• 早期的乳腺癌肝转移可以不表现任何临床不适症状，随 着病情进展，可能会出现肝脏受损的非特异症状：发热、 乏力、纳差、腹胀、体重下降等，继而出现腹水、黄疸、 肝大等临床症状和体征。
概况
肺/胸膜 骨 肝
淋巴结
80% 74% 71% 55%
概况 -- 特点
1）年轻的乳腺癌患者（<50岁）更容易发生肝转移，并且 常常伴随着其他部位的复发转移。
2）手术切除原发灶的乳腺癌患者更容易发生肝转移，其原 因可能是手术切除原发灶一定程度上促进了肿瘤的微 转移与血管形成。
3）对比乳腺癌原发灶与肝转移灶，肿瘤细胞的表型改变。 ER与PR的改变更为明显（下调为主）。
CEA >1000 (Up to 10 ng ml1)
4.9(0.16-51) n-127
1.035(0.4-5.1)* n-8
CEA>10 (Up to 10 ng ml1)
5.26(0.16-32) n-70
4.0(0.16-51)NS n-65
CA15-3 >35 (Up to 35Uml1)
1.Hoe AL, et al,(1991) Breast liver metastases – Incidence,diagnosis and outcome.J R Soc Med 84:714 – 716 2.Zinser JW, et al, (1987)Clinical course of breast cancer patients with liver metastases.J Clin Oncol5:773 – 782. 3. O’Reilly SM, et al,(1990) Liver metastases from breast cancer: the relationship between clinical, biochemical and pathological features and survival. Eur J Cancer26:574 – 577
Biochemical test
Median survival if
(normal range+units) normal (months)
Median survival if abnormal (months)
ALT <50 (Up to 50 IU)
6.0 (0.16 – 51) n-87
2.6 (0.16 – 25)*（* P<0.05)
4.9(0.16-51) n-131
0.6(0.16-1.57)* n-6
Bilirubin >20 (o18mmol l1)
5.1(0.16-51) n-117
1.38(0.16-25)* n-18
GGT >250 (Up to 50 IU)
6.0(0.16-51) n-90
2.67(0.16-31)* n-44
Albumin <35 (35 – 45 g l1)
7.0 (0.27 – 51) n-82
2.0 (0.16 – 27.2)* n-51
Albumin <30 (35 – 45 g l1)
5.86(0.16-51) n-116
1.5(0.16-5.13)* n-20
Bilirubin >50 (o18mmol l1)
6(0.4-32) n-26
4.2(0.16-51)NS n-110
L Wyld,et al,Prognostic factors for patients with hepatic metastases from breast cancer, British Journal of Cancer (2003) 89,284 – 290.
预后—分子分型
• the Department of Oncology, University Hospital of Udine, Italy January 2004 to July 2013
• 回顾性分析了544例已接受抗肿瘤治疗的转移性乳腺癌患者
预后—分子分型
Effect
Visceral metastases–St. Gallen 2013 Luminal B vs. luminal A Luminal HER2 vs. luminal A Non luminal HER2 vs. luminal A TN vs. luminal A Lobular vs. other Anthracyclines neo/adjuvant yes vs. no
n-49
Alkaline phosphatase <1000 (Up to 300iu)
5.13 (0.16 – 51) n-113
1.1 (0.16 – 25)* n-22
Alkaline phosphatase <500 (Up to 300 IU)
6.96 (0.17 – 51) n-89
1.5Leabharlann Baidu (0.16 – 31)* n-46
1. 乳腺癌肝转移的概况及预后 2. 乳腺癌肝转移的内科治疗
概况--乳腺癌首发转移特点
7.3%
肝转移 7.3% 肺转移 22.4% 骨转移 41.1% 脑转移 7.3% 其他 18.9%
Abigail T. Berman,1 Arpi D. Thukral,et al. Incidence and Patterns of Distant Metastases for Patients With Early-Stage Breast Cancer After Breast Conservation Treatment.Clinical Breast Cancer,2013, 13(2):88-94.