肝切除和射频消融治疗乳腺癌术后异时性肝寡转移瘤的临床疗效

摘要

探讨肝切除（HR）和射频消融（RFA）治疗乳腺癌术后异时性肝寡转移瘤（肝转移瘤数量≤3）的临床疗效。回顾性分析2018年1月—2021年12月内江市第一人民医院收治的连续38例乳腺癌术后异时性肝寡转移瘤患者的临床资料。观察组18例，肝寡转移瘤采用HR、RFA，术后根据患者的分子亚型和疾病负荷选择相应的全身治疗方案。对照组20例，选择相应的全身治疗方案。两组均随访3年。统计观察组围手术期相关并发症及术后无瘤生存时间；比较两组1、2、3年的生存率。观察组手术方式包括1例行单纯HR，11例行RFA，另外6例采用HR联合RFA方式，手术均成功，术后未发生治疗相关性死亡，主要并发症包括1例胆瘘和1例肝脓肿。两组术后1、2、3年的生存率差异比较均有统计学意义（P<0.05）。针对乳腺癌术后异时性肝寡转移瘤的患者行HR和RFA治疗是安全有效的，能延长患者无瘤生存时间，提高患者生存率。

关键词

乳腺肿瘤 / 异时性转移 / 肝寡转移瘤 / 肝切除 / 射频消融

参考文献

[1] Bray F , Laversanne M , Sung H , et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3): 229-263. DOI: 10.3322/caac.21834.

[2] 李兰山， 刘鸿皓， 马秋桐， 等 . 基于生物信息学的乳腺癌肝转移标志物和治疗靶点筛选[J]. 中国现代普通外科进展， 2025， 28（10）： 829-835. DOI: 10.3969/j.issn.1009—9905.2025.10.013.

[3] Siegel RL , Miller KD , Wagle NS , et al. Cancer statistics, 2023[J]. CA Cancer J Clin, 2023, 73(1): 17-48. DOI: 10.3322/caac.21763.

[4] Lake K , Mohta S , Smith C , et al. Abstract PO5—25—01: treating liver metastases by reversing cell competition between metastatic cancer cells and hepatocytes[J]. Cancer Res, 2024, 84(9_Supplement): PO5—25—01. DOI: 10.1158/1538—7445.sabcs23—po5—25—01.

[5] Zhang Y , Tan Y , Yuan J , et al. circLIFR—007 reduces liver metastasis via promoting hnRNPA1 nuclear export and YAP phosphorylation in breast cancer[J]. Cancer Lett, 2024, 592: 216907. DOI: 10.1016/j.canlet.2024.216907.

[6] Kim JY , Park JS , Lee SA , et al. Does liver resection provide long—term survival benefits for breast cancer patients with liver metastasis? A single hospital experience[J]. Yonsei Med J, 2014, 55(3): 558-562. DOI: 10.3349/ymj.2014.55.3.558.

[7] 徐娟， 赵晔 . 射频消融联合化学治疗在乳腺癌肝转移中临床效果[J]. 医学研究杂志， 2017， 46（1）： 59-62. DOI: 10.11969/j.issn.1673—548X.2017.01.017.

[8] Etan T , Amir E , Tibau A , et al. National comprehensive cancer network recommendations for drugs without US food and drug administration approval in metastatic breast cancer: A cross—sectional study[J]. Cancer Treat Rev, 2020, 91: 102113. DOI: 10.1016/j.ctrv.2020.102113.

[9] Zhang Y , Tan Y , Yuan J , et al. CircLIFR—007 reduces liver metastasis via promoting hnRNPA1 nuclear export and YAP phosphorylation in breast cancer[J]. Cancer Lett, 2024, 592: 216907. DOI: 10.1016/j.canlet.2024.216907.

[10] Galiandro F , Agnes S , Moschetta G , et al. Prognostic factors in patients with breast cancer liver metastases undergoing liver tesection: dystematic teview and meta—snalysis[J]. Cancers (Basel), 2022, 14(7): 1691. DOI: 10.3390/cancers14071691.

[11] 程文， 魏靖， 张磊 . 超声介导热消融治疗乳腺癌肝转移瘤的应用价值分析[C]//中国超声医学工程学会. 中国超声医学工程学会第五届全国介入超声医学学术交流大会论文汇编， 2019： 218.

[12] Cheung TT , Chok KS , Chan AC , et al. Survival analysis of breast cancer liver metastasis treated by hepatectomy: a propensity score analysis for Chinese women in Hong Kong[J]. Hepatobiliary Pancreat Dis Int, 2019, 18(5): 452-457. DOI: 10.1016/j.hbpd.2019.08.001.

[13] Bacalbasa N , Balescu I , Ilie V , et al. The impact on the long—term outcomes of hormonal status after hepatic resection for breast cancer liver metastases[J]. In Vivo, 2018, 32(5): 1247-1253. DOI: 10.21873/invivo.11372.

[14] Ruiz A , van Hillegersberg R , Siesling S , et al. Surgical resection versus systemic therapy for breast cancer liver metastases: results of a European case matched comparison[J]. Eur J Cancer, 2018, 95: 1-10. DOI: 10.1016/j.ejca.2018.02.024.