乳腺癌根治术后内乳淋巴结首先复发的特点  

Internal mammary lymph node recurrence as the first site of failure after radical mastectomy and/or radiochemotherapy in breast cancer

作　　者：张玉晶[1] 高远红[1] 刘新帆[1] 李晔雄[1] 余子豪[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院放射治疗科,北京100021

出　　处：《中华放射肿瘤学杂志》2001年第3期153-157,共5页Chinese Journal of Radiation Oncology

摘　　要：目的　分析乳腺癌患者经根治术及辅助治疗后以内乳淋巴结为首先复发的临床表现和特点 ,总结其误诊的有关因素。方法　对 31例女性乳腺癌患者进行多项分析 ,包括患者原发乳腺癌的发病和治疗情况、内乳复发病灶的特点、确诊手段、误诊以及对挽救治疗的影响等。本组患者占同期收治乳腺癌女患者的 0 .6 % ,手术时年龄 2 9～ 6 0岁 (中位 44岁 )。根治术后 16例未做正规辅助治疗 ,11例仅做辅助化疗或内分泌治疗 ,4例做了内乳放射结合化疗或内分泌治疗。结果　术后到确诊内乳复发的时间为 8～ 132个月 (中位 34个月 )。复发病灶均表现为胸骨旁隆起或肿块 (直径 2～ 10cm ,中位 5cm) ,伴胸痛、皮肤受累和胸骨破坏 ,其百分比例分别为 6 1.3%、35 .5 %和 6 4.5 % ;45 .2 %的病变跨多个肋间隙 ,病变中心位于上 3个肋间的比例为 90 .0 %。误诊包括胸骨转移 (2 2例 )、胸壁复发 (10例 )、肋软骨炎症 (5例 )等。挽救治疗均包括放射治疗、综合局部切除或全身治疗。内乳淋巴结转移确诊治疗后的 3、5和 10年生存率分别为 6 0 .0 %、2 6 .1%和 12 .9%。复发病灶直径≥ 6cm的患者较病灶直径 <6cm的患者生存时间明显缩短 (P <0 .0 5 ) ,推测可能与治疗延误有关。结论　乳腺癌多数的内乳淋巴结复发位于上 3个肋间。内乳淋巴?Objective To analyze the clinical features and misdiagnosis of the rare internal mammary lymph node recurrence (IMNR) as the first site of failure in female breast cancer patients after radical or modified radical mastectomy with or without adjuvant radiochemotherapy. Methods Thirty one patients with ages 29 to 60 years (median 44 years) were reviewed and their relative parameters were recorded and analyzed such as stage, location of the primary lesion in the breast , adjuvant treatment, size and location of the recurrent tumor ,method of confirmation, misdiagnosis and its influence on the salvage treatment as well as the survival. Results The interval between mastectomy and confirmation of IMNR was 8～132 months (median 34 months). The recurrent disease mainly presented itself as a parasternal mass ranging 2～10?cm(median 5?cm), usually complicated with mild to severe chest pain(61.3%) , cutaneous (35.5%) and sternal ( 64.5% ) invasion. Misdiagnosis included sternal metastasis (22 cases), simple recurrence on the chest wall (10 cases) and inflammation or sclerosis of the ribs (5 cases). 45.2% of the lesions occupied more than one intercostal spaces, with the center in the upper three intercostal spaces in 90.0% of cases. Salvage treatment was mainly radiotherapy with or without local resection and systemic treatment. The survival at 3,5 and 10 years after confirmation of IMNR , beginning from the salvage treatment, was 60.0%, 26.1% and 12.9% respectively. Patients with IMNR not less than 6?cm in diameter survived worse than those with smaller lesions.Conclusions Clinical IMNR is mostly seen in the upper three intercostal spaces, and is often misdiagnosed as sternal metastasis, simple recurrence on the chest wall or inflammation or sclerosis of the ribs. The misdiagnosis and delay of salvage treatment of such IMNR may affect the outcome of the disease.

关 键 词：乳腺癌 内乳淋巴结 复发 误诊 挽救治疗 诊断 外科手术 

分 类 号：R737.9[医药卫生—肿瘤]