选择性残腔切削边缘法在乳腺癌保留乳房手术中的应用  

Application of selective cavity shaving margins in breast-conservingg surgeryforbreast cancer

作　　者：刘安阳[1,2] 于俊平 白熠洲 赵培俍 田金翌[1] 罗斌[1,2] Liu Anyang;Yu Junping;Bai Yizhou;Zhao Peiliang;Tian Jinyi;Luo Bin(Department of General Surgery,Bejing Tsinghua Changgung Hospital/School of Clinical Medicine,T'singhua University,Beijing 102218,China;Department of General Surgery,Xuanwu Hospital,Capital Medical University,Bejing 100053,China.)

机构地区：[1]清华大学附属北京清华长庚医院(清华大学临床医学院)普通外科,北京102218 [2]首都医科大学宣武医院普通外科,北京100053

出　　处：《中华乳腺病杂志（电子版）》2024年第2期102-108,共7页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：目的:探讨乳腺癌保留乳房手术(BCS)选择性残腔切削边缘法(CSM)术中冰冻病理的应用效果。方法:回顾性分析2006年1月至2014年12月首都医科大学附属宣武医院、2015年1月至2021年12月北京清华长庚医院普通外科由同一组医生诊治的303例接受BCS的乳腺癌患者临床资料。所有患者均利用CSM术中冰冻病理评价切缘,采用Kaplan-Meier法计算患者的累积无局部复发生存率(LRFS)、DFS率及OS率,采用单因素分析比较不同临床病理因素患者的局部复发率,通过Log-rank检验比较不同因素对局部复发的影响。结果:303例BCS患者中位随访119个月(范围:23~211个月),11例出现局部复发,复发中位时间为30个月(范围:5~60个月)。303例患者的5年LRFS、DFS和OS率分别为95.9%、95.0%和97.8%;10年LRFS、DFS和OS率分别为95.9%、93.2%和96.6%,10年累积局部复发率为4.1%。原位癌和浸润性癌10年累积局部复发率分别为14.3%及2.9%,差异有统计学意义(χ^(2)=9.490,P=0.002)。原位癌局部复发风险高于浸润性癌(HR=5.539,95%CI:1.45~35.83)。结论:在早期乳腺癌BCS中,术中CSM法是一种安全、可行的方法。它不仅能显著降低再手术的需要,而且还能保持较低的局部复发率。Objective To investigate the application of selective cavity shaving margins(CSM)method combined with intraoperative froze-section pathology in breast-conserving surgery(BCS)of breast cancer patients.Methods A retrospective analysis of clinical data was conducted on 303 breast cancer patients who underwent BCS using the CSM and intraoperative frozen-section pathological evaluation of margins by the same group of surgeons in the Xuanwu Hospital of Capital Medical University from January 2006 to December,2014,and in the Beijing Tsinghua Changgung Hospital from January,2015 to December 2021.The Kaplan-Meier method was used to calculate the cumulative local recurrence-free survival(LRFS),DFS and OS of patients.Univariate analysis was used to compare the local recurrence rates between patients with different clinicopathological factors,and the log-rank test was used to compare the effects of different factors on local recurrence.Results Totally 303 BCS patients were followed up for median 119 months(range:23 to 211 months),and 1l cases experienced local recurrence,with a median recurrence time of 30 months(range:5 to 60 months).The 5-year LRFS,DFS and OS of 303 patients were 95.9%,95.0%,and 97.8%,respectively;the 10-year LRFS,DFS and OS were 95.9%,93.2%,and 96.6%,respectively,with a 10-year cumulative local recurrence rate of 4.1%.The 10-year cumulative local recurrence rates of patients with in situ carcinoma and invasive carcinoma were 14.3%and 2.9%,respectively,indicating a significant difference(χ^(2)=9.490,P=0.002).The patients with in situ carcinoma showed a significantly higher risk compared with patients with invasive carcinoma(HR=5.539,95%Cl:1.45-35.83).Conclusion The intraoperative CSM method is a safe and feasible approach in BCS of early-stage breast cancer.It not only significantly reduces the possibility of reoperation but also maintains a low rate of local recurrence.

关 键 词：乳腺肿瘤 局部切除术 冰冻切片 肿瘤局部复发 

分 类 号：R737.9[医药卫生—肿瘤]