Predictive Factors for Survival in Breast Cancer Patients With Latent Bone Metastases: A Single-Center Retrospective Study

乳腺癌患者潛伏性骨轉移的生存預測因素：單一中心回顧性研究

10.6332/ANMMI.202409_37(3).0002

Hsin-Chang Chen(陳信璋)；Yen-Hsiang Chang(張雁翔)

Breast cancer ； latent bone metastasis ； survival predictors ； visceral metastasis ； 乳腺癌 ； 潛伏性骨轉移 ； 生存預測因素 ； 內臟轉移

核子醫學暨分子影像雜誌

37卷3期（2024 / 09 / 01）

81 - 93

英文;繁體中文

Introduction: Bone metastasis can emerge years after the primary surgery for breast cancer, which is called latent bone metastasis. The prognostic evaluation for patients with this condition is not well understood. This study aims to identify factors that predict survival in breast cancer patients with latent bone metastasis. Methods: This retrospective study analyzed 114 cases of latent bone metastasis from the Kaohsiung Chang Gung Memorial Hospital Database, spanning from 2008 to 2019. We evaluated demographic and clinical characteristics including age at diagnosis of bone metastasis, initial cancer stage, histopathological features, and the presence of visceral metastasis. Laboratory measurements such as alkaline phosphatase, carcinoembryonic antigen, and Cancer Antigen 15-3 (CA15-3) were also considered. Patients were categorized into solitary, oligo-, and multiple metastasis groups based on bone scintigraphy results. Cox proportional hazards regression models identified factors influencing overall survival (OS) post-diagnosis of bone metastasis. Results: The average age at the development of latent bone metastasis was 55 years. Among this group, 92 (81%) died by the end of the follow-up, with a median OS of 33 months. Distribution among metastasis types was 21% solitary, 32% oligo-, and 47% multiple. Visceral metastasis, presenting in 75 patients (66%), was most commonly located in the lungs (60%). Significant predictors of reduced OS included multiple bone metastases, elevated CA15-3 levels, and the presence of visceral metastasis, with the latter being an independent predictive factor (HR = 2.48, 95% CI 1.38-4.44, p = 0.002). The Kaplan-Meier survival analysis revealed that patients with visceral metastasis had a median survival of 26 months, in contrast to 60 months for those without (p < 0.0001). Conclusions: Our study outlines the demographic and clinicopathological characteristics of breast cancer patients with latent bone metastasis, identifying visceral metastasis as the sole significant predictor of OS by multivariate analysis. These findings emphasize the need for vigilant monitoring and tailored treatment strategies for patients at higher risk.

背景：骨轉移可能在乳癌初次手術數年後出現，這種情況被稱為潛伏性骨轉移。對於這種情況下患者的預後評估尚不充分理解。本研究旨在識別預測乳腺癌患者潛伏性骨轉移存活率的因素。方法：這項回顧性研究分析了2008至2019年間高雄長庚紀念醫院資料庫中114例潛伏性骨轉移案例。我們評估了包括骨轉移診斷時的年齡、初始癌症分期、組織病理特徵和內臟轉移的存在等臨床特徵。同時也考慮了如鹼性磷酸酶（alkaline phosphatase, ALK-P）、癌胚抗原（carcinoembryonic antigen, CEA）和癌抗原15-3（Cancer Antigen 15-3, CA15-3）等實驗室數據。根據骨掃描結果，患者被分為單發、少發和多發轉移組。Cox比例風險回歸模型用於確定骨轉移診斷後整體生存（overall survival, OS）的影響因素。結果：潛伏性骨轉移發生的年齡中位數為55歲。在這一組中，92名（81%）患者在追蹤期間死亡，總生存期中位數為33個月。轉移類型分布為單發21%、少發32%和多發47%。75名患者（66%）存在內臟轉移，其中以肺部最常見（60%）。顯著的預後不良預測因素包括多發骨轉移、CA15-3水平高於中位數，以及內臟轉移的存在，其中內臟轉移是獨立的預測因素（HR = 2.44, 95% CI 1.38-4.44, p = 0.002）。Kaplan-Meier生存分析顯示，有內臟轉移的患者中位生存時間為26個月，而無內臟轉移的患者為60個月（p < 0.0001）。結論：我們的研究描述了潛伏性骨轉移乳腺癌患者的臨床與病理特徵，凸顯了骨轉移發生時合併有內臟轉移患者預後較差。這些發現強調了對於高風險患者需要進行積極監測和量身定制的治療策略的重要性。