乳腺癌保留乳房治疗远期疗效的研究  

Long-term results of breast conserving therapy for breast cancer

作　　者：王永胜[1] 孙敏[1] 刘岩松[1] 周正波[1] 李永清[1] 王磊[1] 刘雁冰[1] 李济宇[1] 赵桐[1] 陈鹏[1] 

机构地区：[1]山东省肿瘤医院乳腺病中心,济南250117

出　　处：《中华乳腺病杂志（电子版）》2007年第3期28-32,共5页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：目的探讨临床Ⅰ、Ⅱ期乳腺癌选择性行乳腺癌保留乳房治疗(BCT)的远期生存、同侧乳腺复发(IBR)、美容效果及其相关因素。方法对1985年10月至2000年12月收治的270例Ⅰ、Ⅱ期乳腺癌患者进行BCT远期疗效的临床研究。乳腺癌保乳手术先后采用乳腺象限/区段切除术及肿瘤扩大切除术,联合全腋窝淋巴结清扫术。术后放射治疗先后采用60Co及加速器全乳放射治疗及瘤床缩野照射。结果在10年的中位随访时间内,270例BCT患者10年总生存率83.7%、IBR8.5%、远处转移率23.7%。患者年龄、肿瘤大小、病理组织学类型、腋窝淋巴结转移状况等临床病理因素对BCT后IBR无显著性影响(均P>0.05),切缘阳性、术后未行全乳照射的患者IBR显著升高(均P=0.000)。在确保切缘阴性的前提下,不同切除范围的手术方式对IBR无显著性影响(P=0.799),但切除范围较大的区段/象限切除术对BCT后乳房美容效果有显著不良影响(优秀P=0.043,优秀+良好P=0.005)。结论①临床Ⅰ、Ⅱ期乳腺癌选择性行BCT有较高的远期疗效、较好的美容效果和较低的IBR,可以安全地替代乳房切除性手术。②确保切缘阴性及接受术后全乳放射治疗仍是现阶段乳腺癌BCT的金标准。③在确保切缘阴性的前提下,切除范围较小的肿瘤扩大切除术有较好的美容效果和相同的治疗效果。Objective To evaluate the long-term survival, ipsilateral breast recurrence （IBR） and cosmetic results of breast conservative therapy （BCT） for stage Ⅰ and Ⅱ breast cancer. Method From Oct. 1985 to Dee. 2000, BCT were performed in 270 patients with stage Ⅰ and Ⅱ breast cancer. Breast conserving surgery included quadrantectomy, sector resection, and lumpectomy, combined with whole axillary lymph node dissection. 60Co and accelerator were used for whole breast and booster irradiations. Results Median follow up of 10 years showed the 10-year overall survival, IBR, and distant metastasis rates were 83.7%, 8.5%, and 23.7%, respectively in the 270 patients. While patient age, tumor size, histopathological type, and axillary node status had no relationship with IBR （P 〉0.05 for all）, IBR was significantly high in patients with positive margin and without postoperative whole breast radiation （P = 0.000）. Under the circumstance of assured clear margins, there was no difference of IBR between quadrantectomy/sector resection and lumpectomy （ P = 0. 799）, but the former had poor cosmetic results （P 〈 0. 05）. Conclusions （1） BCT has the effect of high rate of long-term survival, low rate of IBR and good cosmetic results, and can safely replace mastectomy for patients with stage Ⅰ and Ⅱ breast cancer; （2）Clear margin and whole breast irradiation are still gold standard for BCT at the moment; （3）Lumpectomy has better cosmetic results and same curative effect compared to quadrantectomy/sector resection.

关 键 词：乳腺癌 保留乳房治疗 同侧乳腺复发 美容效果 

分 类 号：R737.9[医药卫生—肿瘤]