Objective:To retrospectively analyze the efficacy of pemetrexed combined with platinum in the treatment of breast cancer patients with lung metastases and the relevant prognosis factor.Methods:The clinical data of 44 cases of breast cancer with lung metastasis from July 2011 to July 2016 were retrospectively analyzed.According to the different treatment regimens,the short-and long-term efficacy were analyzed.The clinical features,treatment regimens and prognosis of 44 patients with breast cancer were analyzed by Cox regression analysis and Cox multivariate model.Results:The total effective rate was 61.4％ (27/44) in 44 patients with breast cancer after lung metastases.The clinical efficacy of pemetrexed combined with platinum group (group B) was better than that of gemcitabine combined with chemotherapy group (group A),(76.0％,19/25 vs 42.0％,8/19),the difference was statistically significant (P=0.023).The toxicity of blood,nausea and vomiting occurred in both groups.The incidence of anemia,leukopenia,thrombocytopenia,nausea and vomiting and oral mucositis in group B were significantly lower than those in group A,the difference was statistically significant (P＜0.05).The median follow-up period was 22.5 months (6 to 60 months),the median progression-free survival (PFS) was 14 (95％ CI 6.0-22.1) months,median lung metastases-overall survival (LM-OS) was 41 (95％ CI 30.9-50.1) months,PFS was 49.2％ at 2 years after lung metastasis,and 41.4％ in 5 years after lung metastasis.There was no significant difference between PFS and LM-OS in both groups.The results of univariate and multivariate analysis showed that pathologic type,clinical stage and clinical effect after rescue treatment were prognostic risk factors.Conclusion:The prognosis of lung metastases in breast cancer is poor,especially triple-negative,stage Ⅳ breast cancer with lung metastases and progress after treatment.The use ofpemetrexed combined with platinum-based chemotherapy has a good short-term effect in the treatment of only lung metastasis or lung metastasis with bone metastases in patients with advanced breast cancer with less adverse events,but the patient's long-term prognosis has not been significantly improved.%目的:回顾性分析培美曲塞联合铂类治疗乳腺癌肺转移患者的疗效以及影响乳腺癌肺转移患者预后的相关因素.方法:回顾性分析2011年7月至2016年7月间44例乳腺癌肺转移的临床资料,比较两类不同解救治疗方案的近期和远期疗效,并采用Cox回归分析以及Cox多因素模型分析44例患者的预后相关因素.结果:44例乳腺癌患者肺转移后解救治疗的总有效率为61.4％(27/44),培美曲塞联合铂类化疗组临床有效率[B组,76.0％ (19/25)]优于吉西他滨联合化疗组[A组,42.0％ (8/19)],差异有统计学意义(P=0.023).两组均出现血液学毒性以及恶心、呕吐等不良反应,B组患者中贫血、白细胞减少、血小板降低、恶心、呕吐、口腔黏膜炎的发生率明显低于A组,差异有统计学意义(P＜0.05).44例患者中位随访期22.5(6～60)个月,中位无疾病进展时间(progression free survival,PFS)为14(95％CI 6.0～22.1)个月,中位生存期(lung metastases-overall survival,LM-OS)为41(95％CI 30.9～50.1)个月,肺转移后2年PFS为49.2％,肺转移后5年OS为41.4％.两组的PFS和LM-OS差异均无统计学意义(P＞0.05).单因素分析和多因素分析结果均表明病理分型、临床分期、解救治疗后的临床缓解情况是预后危险因素.结论:乳腺癌肺转移的预后较差,其中三阴型乳腺癌、初始就发现肺转移的Ⅳ期患者以及解救治疗后出现进展预后差.采用培美曲塞联合铂类化疗方案解救治疗仅有肺转移或者肺转移合并骨转移的晚期乳腺癌患者近期疗效较好,不良反应小,但患者的远期预后并没有得到明显改善.
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