摘要
背景与目的：保留乳房手术已成为早期乳腺癌标准术式之一，10余年来已在国内得到广泛开展，本文分析早期乳腺癌保乳治疗的近期疗效及术后乳房美观度的影响因素。方法：回顾分析234例早期乳腺癌患者，在接受保留乳房手术、术后辅助放化疗后的生存率、乳房的外形。结果：1995年10月至2004年7月，234例早期乳腺癌患者接受保乳治疗，包括保乳手术、术后辅助化疗和辅助放疗。全部患者均在门诊得到随访。经过中位随访期22个月（3～100个月），平均随访期29．5个月，随访满3年的患者为75例，3年总生存率96．7％，无病生存率98．7％。局部复发3例，手术至复发间期平均为28．3个月（分别为9，16，60个月）。远处转移8例，手术至远处转移中位问期为12个月（3～48个月）；转移部位：骨4例，肺部2例，锁骨上淋巴结1例，胸膜1例。运用JCRT（Joint Center for Radiation Therapy，放射治疗联合中心）标准对116例患者进行术后乳房外形的评价，优、良、中、差分别为9．5％、48．3％、39．7％、2．6％；肿块位于乳房外上象限的83例患者中，采用两个手术切口乳房外形优良者占70．2％，一个手术切口则为34．6％，具显著性差异（X^2=9．532，P=0．023）；107例患者中，化、放疗序贯进行乳房外形优良者占70．3％，化、放疗同时进行则为54．3％，无显著性差异（X^2=2．765，P=0．429）。结论：保乳治疗对于早期乳腺癌患者而言安全可行。采用适当的术式可以保证术后良好的乳房外形。
Background and purpose： Breast conserving surgery is becoming one of the standard management types for patients with early stage breast cancer. In the past decade, breast conservative treatment has been widely accepted and used around the country. This paper is to study the effect of cosmetic results for the patients with early stage breast cancer after breast-conserving treatment. Methods： The survival rate and cosmetic results were retrospectively analyzed for 234 patients with early stage breast cancer who received breast-conserving surgery, post-operative chemotherapy and radiotherapy. Results： From October, 1995 to July, 2004, 234 patients with early stage breast carcinoma received breast-conserving treatment followed by post-operative chemotherapy and radiotherapy. All the patients were followed up with the median period 22 months （ range 3 - 100 months） and the average 29.5 months. 75 cases of them have been followed up over 3 years. The 3 year overall survival rate was 96.7%, and disease free survival rate was 98.7%. 3 cases experienced local relapse. The average interval between operation and relapse was 28.3 months （9, 16 and 60 months）. Distant metastases were found in 8 cases with 4 cases in bone, 2 cases in lung, 1 case in supraclavicular lymph node and 1 case in plural. The median interval between operation and metastasis was 12 months （3 -48 months）. The cosmetic results were evaluated according to the JCRT（Joint Center for Radiation Therapy） criteria. 116 patients were classed to 4 grades： excellent （9.5%）, good （48.3%）, fair （39.7%）, poor （2.6%）. In 83 cases with upper-outer quadrant tumors, excellent and good cosmetic results were found in 70.2% patients with two incisions, and 34.6% in one incision group. Statistical difference existed between two groups （X^2 =9. 532, P =0.023）. In 107 patients who received chemotherapy and radiotherapy, excellent and good cosmetic results were found in 70.3% patients with sequential treatment, and 54.3% in concurrent treatment group. No statistical significance was found （X^2 = 2. 765, P = 0.429）. Conclusions： For early stage breast cancer patients, breastconservative surgery including tumorectomy and auxiliary dissection followed by post-operative adjuvant chemotherapy and radiotherapy lead to excellent local control. Appropriate operative methods lead to good cosmetic results.
出处
《中国癌症杂志》
CAS
CSCD
2006年第9期697-700,共4页
China Oncology
基金
上海市乳腺癌临床医学中心经费资助
