保留乳头乳晕复合体的乳腺癌改良根治术后即时重建的肿瘤学安全性和预后影响因素分析  

Oncological safety and prognosis factors analysis of immediate breast reconstruction after nippleareola-complex sparing mastectomy

作　　者：厉子杰 张培 张薇 张震 王希梅 肖春花 Li Zifie;Zhang Pei;Zhang Wei;Zhang Zhen;Wang Ximei;Xiao Chunhua(The First Department of Breast Cancer,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin,Tianjin＇s Clinical Research Center for Cancer,Key Laboratory of Breast Cancer Prevention and Therapy,Tianjin Medical University,Ministry of Education,Tianjin 300060,China（Li Z J,Zhang P,Zhang W,Zhang Z,Wang XM,Xiao CH)

机构地区：[1]天津医科大学肿瘤医院乳腺肿瘤一科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室天津市恶性肿瘤临床医学研究中心乳腺癌防治教育部重点实验室,300060

出　　处：《中华肿瘤杂志》2018年第9期690-695,共6页Chinese Journal of Oncology

摘　　要：目的探讨保留乳头乳晕复合体（NAC）的乳腺癌改良根治术后即时重建（NSM＋IBR）的肿瘤学安全性，并分析影响NSM＋IBR预后的因素。方法收集天津市肿瘤医院2004年1月至2015年12月的118例行NSM＋IBR的Ⅰ～ⅡA期乳腺癌患者资料，以同期收治的75例行未保留NAC的乳腺癌改良根治术后即时重建（MRM＋IBR）的Ⅰ～ⅡA期患者作为对照，回顾性分析两组患者的预后，并分析影响NSM＋IBR组患者预后的因素。结果NSM＋IBR组患者的中位随访时间为53个月，术后3年内远处转移6例，局部复发4例，NAC脱落4例，死亡9例，3年局部复发率（LRR）为3.4%，3年无病生存率为91.5%，3年总生存率为92.4%。MRM＋IBR组患者的中位随访时间为51个月，术后3年内远处转移4例，局部复发1例，死亡3例，3年LRR为1.3%，3年无病生存率为93.3%，3年总生存率为96.0%。两组患者的3年LRR、3年无病生存率和3年总生存率差异无统计学意义（均P〉0.05）。人表皮生长因子受体2（HER－2）状态和分子分型是影响NSM＋IBR患者无病生存的独立因素（均P〈0.05），分子分型是影响NSM＋IBR患者总生存的独立因素（P〈0.05）。结论NSM＋IBR不会影响早期乳腺癌患者的预后，且可以保证肿瘤学安全性，维持女性患者的形象，提高生活质量。HER－2状态和分子分型是影响NSM＋IBR患者无病生存的独立因素，分子分型是影响NSM＋IBR患者总生存的独立因素。Objective To explore the oncological safety of immediate breast reconstruction after nipple-areola complex （NAC） sparing mastectomy （NSM ＋IBR） in patients with early stage breast cancer, and to analyze the prognostic factors of NSM＋IBR. Methods From January 2004 to December 2015, the clinical data of 118 cases of stage Ⅰ -Ⅱ A breast cancer who had undergone NSM＋IBR in Tianjin Tumor Hospital were collected, comparing with 75 cases ofⅠ -ⅡA breast cancer patients who had undergone immediate breast reconstruction after modified radical mastectomy （ MRM ＋ IBR） at the same period. In addition to the prognosis of these two groups, the prognostic factors were also retrospectively analyzed. Results The median follow-up were 53 months in the NSM＋IBR group and 51 months in the MRM＋IBR group, respectively. In the NSM＋IBR group, local recurrence, distant metastasis, death and NAC necrosis occurred in 4, 6, 9 and 4 cases during 3 years after operation, respectively. The local recurrence rate （LRR） was 3.4%, 3-year disease-free survival （DFS） rate was 91.5%, and the overall survival （OS） rate was 92.4%. In the MRM＋IBR group, local recurrence, distant metastasis, and death occurred in 1, 4, and 3 cases during 3 years after operation, respectively. The LRR was 1.3%, 3-year DFS was 93.3%, whereas the OS rate was 96.0%. No statistical difference was noted between the two groups （all P〉0.05）. That HER-2 positive and molecular type correlated with the 3-year DFS （P〈O. 05） independently and molecular type correlated with OS （P〈0.05） independently in the NSM＋IBR group. Conclusions NSM does not impair patients＇ prognosis and could ensure oncologieal safety of patients with early stage breast cancer. IBR could improve female patients＇ figure and ensure the quality of life. HER-2 status and molecular type are the independent prognostic factors of the 3-year DFS. Molecular type is the independent prognosis factor of OS.

关 键 词：乳头乳晕复合体 即刻乳房重建 肿瘤学安全性 预后 

分 类 号：R737.9[医药卫生—肿瘤]