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

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

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。

Background and Purpose. Cancer metastasis to bone marrow (BM) is universal-ly a poor prognostic feature. Awareness of BM metastasis by simple blood test and confirmedby 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 di-agnosed by BM aspiration. Methods. Retrospective review of 1330 BM aspirations carried out in Cathay General Hospital between March 2007 and December 2014. Patients with pres-ence 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%), thrombocytope-nia (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 significantbetter sur-vival 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.