摘要
目的观察经免疫组织化学分型的乳腺癌综合治疗疗效,为临床治疗提供参考。方法随访山西省肿瘤医院2010年1月至2012年12月治疗的1240例乳腺癌患者,其中导管型883例;人表皮生长因子受体-2(HER-2)型260例;三阴性乳腺癌(TNBC)97例。保乳术(BCS)或术前新辅助化疗,或术后放化疗的共275例;改良根治术(IRM)和术前新辅助化疗,或术后放化疗的共965例。BCS和IRM后,均行术后常规患侧全乳房、全胸壁调强放疗(IMRT)和锁骨淋巴引流区放疗,DT约50 Gy。腋窝淋巴转移阳性者,补照腋窝区DT 60~70 Gy。雌激素受体(ER)阳性者,行辅助性内分泌治疗。HER-2阳性者,加用曲妥珠单克隆抗体靶向药物治疗。结果BCS和IRM患者的五年生存率分别是81.8%和78.2%(P>0.05),其中腋窝淋巴结无转移者为91.8%;1~3个淋巴结转移者为74.0%;4个以上转移者为63.0%。4个以上淋巴结转移者和无转移者五年生存率差异具有统计学意义(P<0.01)。导管型五年生存率为98.0%;HER-2型为37.7%;TNBC型为17.5%。结论导管型对内分泌治疗敏感,预后最好;HER-2型对抗HER-2靶向药物有效,预后居中;TNBC型具有较强的侵袭性,且对内分泌和靶向药物治疗效果有限,预后最差。免疫组织化学分型和腋窝淋巴结转移数的多少,是影响预后的重要因素之一。
Objective To observe the therapeutic effectiveness of comprehensive treatment for breast can-cer,and to provide reference for clinical therapy.Methods A total of 1240 breast cancer patients were followed up from January 2010 to December 2012 in Shanxi Provincial Cancer Hospital,including 883 cases of ductal type,260 cases of human epidermal growth factor receptor-2(HER-2)type,and 97 cases of triple negative breast cancer(TNBC).There were a total of 275 cases of breast conserving surgery(BCS),preoperative neoadjuvant chemothera-py,or postoperative radiotherapy and chemotherapy;and 965 cases of modified radical mastectomy(IRM),preop-erative neoadjuvant chemotherapy,or postoperative radiotherapy and chemotherapy.After BCS and IRM,routine postoperative whole breast,whole chest wall intensity modulated radiotherapy(IMRT),and clavicular lymph drainage area radiotherapy were performed on both sides,with a DT of approximately 50 Gy.For patients with positive axillary lymph node metastasis,supplementary irradiation was administered to the axillary region with a dose of 60-70 Gy.For those who were ER positive,adjuvant endocrine therapy was administered.For patients who were HER-2 positive,trastuzumab monoclonal antibody targeted therapy was added.Results The five-year survi-val rates of BCS and IRM were 81.8%and 78.2%,respectively(P>0.05).Among them,those without axillary lymph node metastasis had a survival rate of 91.8%;those with 1-3 axillary lymph node metastases had a survival rate of 74.0%;and those with more than 4 axillary lymph node metastases had a survival rate of 63.0%.There was a statistically significant difference in the five-year survival rate between patients with more than four lymph node metastases and those without metastases(P<0.01).The five-year survival rates for ductal sutype,HER-2 sutype and TNBC sutype were 98.0%,37.7%and 17.5%,respectively.Conclusion The ductal sutype is sensitive to en-docrine therapy and has the best prognosis.The HER-2 subtype responds well to HER-2 targeted drugs,with a moderate prognosis.TNBC subtype is characterized by strong invasiveness,limited efficacy of endocrine and tar-geted therapy,and the poorest prognosis.Immunohistochemical subtype and the extent of axillary lymph node metastasis are important factors affecting prognosis.
作者
王帆
齐立强
韩国晖
黄莉
杨文福
白玮
刘洋
王鹤皋
Wang Fan;Qi Liqiang;Han Guohui;Huang Li;Yang Wenfu;Bai Wei;Liu Yang;Wang Hegao(Department of Breast Surgery,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital of Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan,Shanxi 030013,China;Department of Breast Surgery,Cancer Hospital of Chinese Academy of Medical Sciences,Beijing 100021,China;Department of Radiotherapy,Shanxi Province Cancer Hospital,Shanxi Hospi-tal Affili-ated to Cancer Hospital of Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical U-niversity,Taiyuan,Shanxi 030013,China)
出处
《中国药物与临床》
CAS
2024年第3期183-186,共4页
Chinese Remedies & Clinics
