乳腺癌癌前病变二级预防的临床研究  

Secondary prevention and treatment of precancerous lesions of breast cancer

作　　者：花亚伟[1] 张占东[1] 孔晔[1] 张斌[1] 徐虹[3] 马飞 张永磊 

机构地区：[1]河南省肿瘤医院普外科,郑州450003 [2]郑州大学附属肿瘤医院普外科,郑州450003 [3]河南省肿瘤研究所基础研究室,郑州450003

出　　处：《国际外科学杂志》2011年第9期608-611,F0003,共5页International Journal of Surgery

基　　金：基金项目：河南省科技厅普通科技攻关项目（No.0224630023）

摘　　要：目的系列研究乳腺癌的二级预防，探讨其癌前病变演化进展的阻断措施和降低其发病率的方法。方法对乳腺癌癌前病变导管增生、不典型增生、导管上皮内瘤变、小叶上皮内瘤变行区段切除原发病灶后检测与乳腺癌相关激素受体ER、PR、c—erbB-2、P53，个体化综合治疗：ER、PR阳性表达患者服用三苯氧胺，绝经后患者服用阿那曲唑降低雌激素水平；c—erbB-2阳性表达患者，首先化疗，后综合治疗；术前细胞诊断恶性患者，清扫同侧腋下淋巴结；观察并随访。结果乳腺癌癌前病变不典型增生75例中，ER、PR阳性表达86．6％，c—erbB-2灶性弱阳性表达1例，P53均未表达；乳腺导管上皮内瘤变和小叶上皮内瘤变51例中，ER、PR阳性表达84．6％，c—erbB-2阳性表达4％，1753阳性表达4％。腋下淋巴结反应性增生分别为0／9～0／18。结论乳腺导管增生、不典型增生、导管上皮内瘤变、小叶上皮内瘤变是全身性疾病在乳腺局部表现的临床症状，在促癌因素共同作用下进展，局部切除原发病灶，结合免疫组化表达综合治疗（内分泌、化疗、放疗）是阻断疾病演化进展的有效措施，是降低乳腺癌发病率的有效方法。Objective To practice second-level prevention of breast cancer, conduct serial experiments on blocking precancerous ehange of breast cancer thus reduce its incidence rate. Methods After the segment resection of primary lesions the breast precancerous lesions with duetal hyporplasia （DH） atypical duetal hyperplasia （ADH） and ductal intraepithelial neoplasia （DCIS）, lobular intraepithelial neoplasia （LCIS） ,detected hormone receptors ER, PR and c-erbB-2, P53 were detected. With individualized com- prehensive treatment, the positive patients with ER and PR was treated with tamoxifen; the postmenopausal patients took anastrozole to reduce the levels of estrogen; the positive patients with e-erbB-2 were treated with chemotherapy and the combined treatment; the patients with preoperative diagnosis of malignant ceils were taken with the ipsilateral axillary lymph node dissection; all patients were observed and followed up. Results There were 126 cases of the breast precancerous lesions from 1992 to 2008, including 75 cases of ADH with the positive rates of ER and PR 86.6% , c-erbB-2 1.33%, P53 0 ; 51 cases of DCIS and LCIS with the positive rates of ER and PR 84.6%, c-erbB-2 4% ,P53 4% ; Axillary lymph node reactive hyperplasia were 0/9 -0/18. Conclusions Breast precancerous lesions of ADH, DCIS, LCIS are local symptoms of the systemic disease, the segment resection of primary lesions and comprehensive treatment （ endocrine, chemotherapy, radiotherapy） based on immunohistochemical expression are effective through which the incidence rate of breast cancer could be largely controlled or suppressed.

关 键 词：癌前病变 综合治疗 二级预防 

分 类 号：R737.9[医药卫生—肿瘤]