目的:探讨局部晚期乳腺癌(locally advanced breast cancer,LABC)行即刻乳房再造术(immediate breast reconstruction,IBR)的肿瘤学安全性。方法:回顾性分析2001年9月至2016年3月于天津医科大学肿瘤医院被诊断为LABC并行IBR的114例患者...目的:探讨局部晚期乳腺癌(locally advanced breast cancer,LABC)行即刻乳房再造术(immediate breast reconstruction,IBR)的肿瘤学安全性。方法:回顾性分析2001年9月至2016年3月于天津医科大学肿瘤医院被诊断为LABC并行IBR的114例患者的临床资料,分析总体生存(overall survival,OS)率、无局部复发生存(local recurrence-free survival,LRFS)率和无远处转移生存(distant metastasis-free survival,DMFS)率。采用Cox比例风险回归模型分析影响预后的因素。结果:中位随访时间为55.0个月,总队列5年OS率、LRFS率和DMFS率分别为78.9%(95%CI:69.1%~85.9%)、95.8%(95%CI:89.2%~98.4%)和78.9%(95%CI:69.1%~86.0%)。肿瘤直径>5 cm较肿瘤直径≤5 cm患者更易局部复发(P=0.023)。Cox比例风险回归模型多因素分析显示,肿瘤直径>5 cm(HR=3.60,95%CI:1.40~9.10,P=0.007)与淋巴结病理分期N3(HR=4.20,95%CI:1.60~11.0,P=0.004)是患者死亡的独立危险因素。结论:LABC行IBR术式的总体肿瘤学安全性可靠。肿瘤直径>5 cm或淋巴结病理分期为N3的LABC患者应慎行IBR。展开更多
目的探讨局部晚期乳腺癌(locally advanced breast cancer,LABC)根治术中胸壁大面积缺损的有效修复方法。方法对40例LABC患者经新辅助化疗后,13例于根治术后利用转移背阔肌皮瓣联合游离植皮修复大面积胸壁缺损,27例采用游离植皮的方法...目的探讨局部晚期乳腺癌(locally advanced breast cancer,LABC)根治术中胸壁大面积缺损的有效修复方法。方法对40例LABC患者经新辅助化疗后,13例于根治术后利用转移背阔肌皮瓣联合游离植皮修复大面积胸壁缺损,27例采用游离植皮的方法修复。结果背阔肌皮瓣联合游离植皮组术后全部一期愈合(一期愈合率100%),游离植皮修复组中18例一期愈合(一期愈合率66.7%)。结论对于新辅助化疗有效的LABC患者可以应用转移背阔肌皮瓣联合游离植皮修复根治术后的大面积胸壁缺损,手术成功率高。展开更多
Locally Advance Breast Cancer refers to a heterogeneous group of breast cancer with locally extensive disease, which may or may not involve the nodes, without any distant metastases. The study was conducted at Faisala...Locally Advance Breast Cancer refers to a heterogeneous group of breast cancer with locally extensive disease, which may or may not involve the nodes, without any distant metastases. The study was conducted at Faisalabad Medical University (FMU), Oncology, Allied Hospital Faisalabad (Pakistan). Data of 100 patients with LABC was collected. Demographics were recorded in the form of age, socio-economic status. In clinical data, time of presentation, family history of breast cancer, the presenting symptom in the form of lump, ulceration and other skin changes were noted. Histo-pathological variables including tumor size, histopathology, Bloom & Richardson grading, estrogen receptor (ER), progesterone receptor status (PR) and HER2 status. Results showed that after following a standard trimodality treatment approach in LABC patients, 30 percent died within two years. Disease free survival for more than two years was observed in only 25% of patients. Whereas, 70% patients had eventful (Recurrence/metastases) survival. This poor outcome was observed due to lack of health care facilities, awareness and poor socioeconomic status.展开更多
Objective: The purpose of the study was to correlate between effect of pre-neoadjuvant chemotherapy(NACT) and post-NACT clinical, sonographic and pathologic features of the tumor and axillary lymph nodes(ALNs) and to ...Objective: The purpose of the study was to correlate between effect of pre-neoadjuvant chemotherapy(NACT) and post-NACT clinical, sonographic and pathologic features of the tumor and axillary lymph nodes(ALNs) and to raise the possibility of applying the concept of sentinel lymph node biopsy(SLNB) in patients with initially positive ALNs before NACT. Methods: A prospective study of 50 female patients with locally advanced breast cancer(LABC) with clinically palpable and cytologically(under ultrasonographic guidance) positive ALNs. All patients received NACT and then referred for ultrasonographic assessment of the axilla regarding any detectable sonographic criteria of metastatic deposits in ALNs as well as the tumor size in relation to its pre-chemotherapy size. All patients were then subjected either to modified radical mastectomy or breast conserving surgery. The clinical, sonographic and pathological response of the tumor and the ALNs were documented, classified and correlated with each other. Results: Patients' mean age was 47.7 ± 9.1 years. The mean clinical tumor size was 6.7 ± 1.4 cm; stage IIIA that was presented in 32 patients(64%) and IIIB was presented in 18 patients(36%). Chemotherapy was given for a median of 4 cycles. there was reduction of the mean clinical tumor size from 6.7 ± 1.4 cm to 4.3 ± 2.7 cm(P < 0.001). Clinical response was complete in 5(10%) tumors, complete pathological tumor response(post-neoadjuvant) was detected in 8(16%) of patients. Complete clinical nodal response(post-neoadjuvant) in 23(46%) axillae, on sonographic assessment of the axilla, response was complete in 17(34%) axillae. Complete pathological nodal response occurred in 16(32%) axillae. Out of 17 axillae that showed complete sonographic response 11 axillae showed complete pathological nodal response(P < 0.001). Conclusion: Formal axillary lymph node dissection can be avoided and replaced by SLNB post NACT in patients with LABC with metastatic ALNs if there were complete clinical and sonographic criteria of nodal response as well as complete pathological tumor response.展开更多
Objective: The aim of our study was to assess the value of dynamic contrast-enhanced magnetic resonance imaging (DMRI) in predicting early response to neoadjuvant chemotherapy (NAC) in patients with locally advanced b...Objective: The aim of our study was to assess the value of dynamic contrast-enhanced magnetic resonance imaging (DMRI) in predicting early response to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer (LABC) and to assess the accuracy of DMRI in evaluating residual disease after NAC. Methods: DMRI were performed in 43 women with LABC (44 lesions, all were invasive ductal carcinoma) before, after the first and final cycle of NAC. Tumour volume, early enhanced ratio (E1), maximum enhanced ratio (Emax), and maximum enhanced time (Tmax), dynamic signal intensity-time curve were obtained during treatment. Residual tumour volumes obtained using DMRI were compared with pathological findings to assess the accuracy of DMRI. Results: After 1st cycle of NAC, the mean volume of responders decreased insignificantly, P > 0.05, but after NAC, mean volume of residual tumor decreased significantly (P < 0.01). Morphology change: 29 cases showed a concentric shrinkage pattern while 7 cases showed a dendritic shrinkage pattern. Significant differences were found in E1, Emax and Tmax between responders and non-responders (P < 0.05). After 1st cycle of NAC, E1, Emax and Tmax of responders changed significantly (P < 0.001); while there is no significant change in non-responders (P > 0.05). After NAC, dynamic signal intensity-time types were changed in responders, and tended to be significantly flattening, while no significant change was found in non-responders. The residual tumour volume correlation coefficient between DMRI and pathology measurements was very high (r = 0.866, P = 0.000). Conclusion: DMRI is useful to evaluate the early response to NAC in LABC. The presence and volume of residual disease in LABC patients treated with NAC could be accurately evaluated by DMRI.展开更多
文摘目的探讨局部晚期乳腺癌(locally advanced breast cancer,LABC)根治术中胸壁大面积缺损的有效修复方法。方法对40例LABC患者经新辅助化疗后,13例于根治术后利用转移背阔肌皮瓣联合游离植皮修复大面积胸壁缺损,27例采用游离植皮的方法修复。结果背阔肌皮瓣联合游离植皮组术后全部一期愈合(一期愈合率100%),游离植皮修复组中18例一期愈合(一期愈合率66.7%)。结论对于新辅助化疗有效的LABC患者可以应用转移背阔肌皮瓣联合游离植皮修复根治术后的大面积胸壁缺损,手术成功率高。
文摘Locally Advance Breast Cancer refers to a heterogeneous group of breast cancer with locally extensive disease, which may or may not involve the nodes, without any distant metastases. The study was conducted at Faisalabad Medical University (FMU), Oncology, Allied Hospital Faisalabad (Pakistan). Data of 100 patients with LABC was collected. Demographics were recorded in the form of age, socio-economic status. In clinical data, time of presentation, family history of breast cancer, the presenting symptom in the form of lump, ulceration and other skin changes were noted. Histo-pathological variables including tumor size, histopathology, Bloom & Richardson grading, estrogen receptor (ER), progesterone receptor status (PR) and HER2 status. Results showed that after following a standard trimodality treatment approach in LABC patients, 30 percent died within two years. Disease free survival for more than two years was observed in only 25% of patients. Whereas, 70% patients had eventful (Recurrence/metastases) survival. This poor outcome was observed due to lack of health care facilities, awareness and poor socioeconomic status.
文摘Objective: The purpose of the study was to correlate between effect of pre-neoadjuvant chemotherapy(NACT) and post-NACT clinical, sonographic and pathologic features of the tumor and axillary lymph nodes(ALNs) and to raise the possibility of applying the concept of sentinel lymph node biopsy(SLNB) in patients with initially positive ALNs before NACT. Methods: A prospective study of 50 female patients with locally advanced breast cancer(LABC) with clinically palpable and cytologically(under ultrasonographic guidance) positive ALNs. All patients received NACT and then referred for ultrasonographic assessment of the axilla regarding any detectable sonographic criteria of metastatic deposits in ALNs as well as the tumor size in relation to its pre-chemotherapy size. All patients were then subjected either to modified radical mastectomy or breast conserving surgery. The clinical, sonographic and pathological response of the tumor and the ALNs were documented, classified and correlated with each other. Results: Patients' mean age was 47.7 ± 9.1 years. The mean clinical tumor size was 6.7 ± 1.4 cm; stage IIIA that was presented in 32 patients(64%) and IIIB was presented in 18 patients(36%). Chemotherapy was given for a median of 4 cycles. there was reduction of the mean clinical tumor size from 6.7 ± 1.4 cm to 4.3 ± 2.7 cm(P < 0.001). Clinical response was complete in 5(10%) tumors, complete pathological tumor response(post-neoadjuvant) was detected in 8(16%) of patients. Complete clinical nodal response(post-neoadjuvant) in 23(46%) axillae, on sonographic assessment of the axilla, response was complete in 17(34%) axillae. Complete pathological nodal response occurred in 16(32%) axillae. Out of 17 axillae that showed complete sonographic response 11 axillae showed complete pathological nodal response(P < 0.001). Conclusion: Formal axillary lymph node dissection can be avoided and replaced by SLNB post NACT in patients with LABC with metastatic ALNs if there were complete clinical and sonographic criteria of nodal response as well as complete pathological tumor response.
文摘Objective: The aim of our study was to assess the value of dynamic contrast-enhanced magnetic resonance imaging (DMRI) in predicting early response to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer (LABC) and to assess the accuracy of DMRI in evaluating residual disease after NAC. Methods: DMRI were performed in 43 women with LABC (44 lesions, all were invasive ductal carcinoma) before, after the first and final cycle of NAC. Tumour volume, early enhanced ratio (E1), maximum enhanced ratio (Emax), and maximum enhanced time (Tmax), dynamic signal intensity-time curve were obtained during treatment. Residual tumour volumes obtained using DMRI were compared with pathological findings to assess the accuracy of DMRI. Results: After 1st cycle of NAC, the mean volume of responders decreased insignificantly, P > 0.05, but after NAC, mean volume of residual tumor decreased significantly (P < 0.01). Morphology change: 29 cases showed a concentric shrinkage pattern while 7 cases showed a dendritic shrinkage pattern. Significant differences were found in E1, Emax and Tmax between responders and non-responders (P < 0.05). After 1st cycle of NAC, E1, Emax and Tmax of responders changed significantly (P < 0.001); while there is no significant change in non-responders (P > 0.05). After NAC, dynamic signal intensity-time types were changed in responders, and tended to be significantly flattening, while no significant change was found in non-responders. The residual tumour volume correlation coefficient between DMRI and pathology measurements was very high (r = 0.866, P = 0.000). Conclusion: DMRI is useful to evaluate the early response to NAC in LABC. The presence and volume of residual disease in LABC patients treated with NAC could be accurately evaluated by DMRI.
