Hematologic Manifestation of Cancer Bone Marrow Metastasis－a Retrospective Review of a Medical Center in Taiwan

癌症骨髓轉移的血液表現－台灣一家醫學中心的回溯性分析

宋詠娟(Yung-Chuan Sung) ； 陳苓萍(Ling-Ping Chen) ； 施盈逸(Ying-Yih Shih) ； 張園鑫(Yuan-Hsin Chang) ； 劉惠文(Hui-Wen Liu)

《輔仁醫學期刊》 14卷4期 (2016/12) Pp. 185-196

https://doi.org/10.3966/181020932016121404002

摘要

Background and Purpose. Cancer metastasis to bone marrow (BM) is universally a poor prognostic feature. Awareness of BM metastasis by simple blood test and confirmed by BM examination is crucial to improve treatment outcome. The aim of this study was to investigate the hematologic manifestation of adult patients with cancer BM metastases diagnosed by BM aspiration. Methods. Retrospective review of 1330 BM aspirations carried out in Cathay General Hospital between March 2007 and December 2014. Patients with presence of cancer BM metastasis were the study group. Patients with normal appearance of BM were the control group. Basic clinical characteristics, complete blood counts and survival of patients were obtained from the hospital records. Results. Twenty-nine patients (2.2%) had evidence of cancer BM metastasis. Breast cancer (34.5%) and colorectal cancer (17.2%) were the most common cancers associated with BM metastasis. As compare with the control group, BM metastasis patients had more cases of anemia (100% vs. 74.9%), thrombocytopenia (82.8% vs. 24.6%), leukoerythroblastosis (69% vs. 2.2%) and high lactate dehydrogenase (LDH) (90% vs. 38.2%). The most common site of metastasis other than BM was bone (n=25, 86.2%). Median survival after BM metastasis was 1.9 months and 6-month survival rate was 21.4%. Patients who received chemotherapy after BM metastasis had significant better survival with medium survival of 5.4 months vs. 0.7 months. Conclusion. BM metastasis by cancer carries a poor prognosis. Anemia, thrombocytopenia, leukoerythroblastosis and high LDH suggest of possible BM metastasis. BM examination provides a quick way to detect metastasis. Patients who received chemotherapy had better survival.

關鍵字

Bone marrow ； metastasis ； leukoerythroblastosis

並列摘要

背景和目的：癌症骨髓轉移的預後不良，如何利用簡單的血液檢驗察覺骨髓轉移加以確診並治療以改善存活極為重要。本研究即希望找出成人癌症骨髓轉移常見之血液表現。方法：利用回溯性方法整理2007年3月至2014年12月間於國泰醫院所作之1330例骨髓檢查，有癌症骨髓轉移者為實驗組，正常骨髓者為對照組，由病歷資料中查詢病人基本臨床特徵、全血球計數及存活狀態加以比較。結果：29位病人有癌症骨髓轉移，乳癌及結直腸癌為最常發生骨髓轉移的癌症。癌症骨髓轉移者有較多之貧血、血小板減少症、白血球紅血球芽細胞症及血清乳酸去氫脢增加。除骨髓外最常見的轉移部位為骨骼。骨髓轉移後的中位存活1.9個月，6個月存活率21.4%。接受化學治療者有明顯的存活優勢，中位存活5.4個月，未接受化學治療者僅0.7個月。結論：貧血、血小板減少症、白血球紅血球芽細胞症及乳酸去氫脢增加可推測有癌細胞骨髓轉移。骨髓檢查能快速診斷出骨髓轉移，接受化學治療的病人有較佳之存活。

並列關鍵字

骨髓 ； 轉移 ； 白血球紅血球芽細胞症