可手术乳腺癌6263例临床分析

Clinical Analysis of Resectable Breast Cancer: a Report of 6 263 Cases

背景与目的:欧、美国家的乳腺癌患者以中老年居多,中位年龄约57岁左右;改良根治术已取代传统根治术而被称为标准根治术,早期患者则行保乳手术;肿瘤的分期(尤其淋巴结状况)明显影响预后;辅助治疗能提高疗效。在国内,有关乳腺癌临床研究的大宗报道甚少。本研究分析我院可手术乳腺癌6263例的临床特点、手术方式与治疗效果,分析影响预后的因素和辅助治疗的作用等情况,以期提高乳腺癌的诊治水平。方法:将我院1964年6月～2003年6月收治的6263例可手术乳腺癌的临床资料输入计算机并分析可手术乳腺癌患者年龄的分布和临床特点。用SPSS10.0统计软件,分析手术术式与治疗效果以及影响预后的因素和辅助治疗的作用等情况。结果:6263例可手术乳腺癌中,女性占98.8%。按每5岁年龄段计算,45～49岁最多(25.2%)。按每10岁年龄段计算,40～49岁最多(41.0%)。临床表现以乳腺肿块为主(96.2%)。全组总5年和10年生存率分别为75.2%和40.4%,0～Ⅰ期、Ⅱ期和Ⅲ期的5年生存率分别为96.8%、73.7%和46.4%,10生存率则分别为78.7%、64.6%和33.5%。腋窝淋巴结阴性和阳性的5年生存率分别为80.3%和55.6%,而10年生存率分别为59.2%和31.9%。20世纪80年代后作传统根治术和改良根治术后各期的5年和10年生存率相比较,均无统计学意义(P>0.05)。

BACKGROUND & OBJECTIVE: In Europe and America, breast cancer commonly occurs in women of middle and old age, the median age of patients is about 57 years old. Modified radical mastectomy has taken the place of traditional radical mastectomy, and is called standard radical mastectomy. Patients with breast cancer of early stage commonly receive breast conservative therapy. TNM stage (especially the lymph node status) affects the prognosis, and adjuvant therapy can improve the survival. In China, just a few clinical researches of large amounts of breast cancer patients have been reported. This study was to analyze clinical feature, surgical patterns, treatment outcome of resectable breast cancer, and explore prognostic factors and the effect of adjuvant therapy, for the sake of improving the levels of diagnosis and treatment. METHODS: Records of 6 263 patients with resectable breast cancer, admitted in our hospital from Jun. 1963 to Jun. 2003, were analyzed retrospectively. RESULTS: Of the 6 263 patients, 98.8% were women. Breast cancer occurred most frequently in patients of 40-49 years old (41.0%), especially in patients of 45-49 years old (25.2%). Breast lump was the main clinical manifestation, and occurred in 96.2% of the patients. The 5-, and 10-year survival rates of all patients were 75.2%, and 40.4%. Of the patients in TNM stages 0-Ⅰ,Ⅱ, and Ⅲ, the 5-year survival rates were 96.8%, 73.7%, and 46.4%, respectively; the 10-year survival rates were 78.7%, 64.6%, and 33.5%, respectively. The 5-, and 10-year survival rates were higher in lymph node negative group than in lymph node positive group (80.3% vs. 55.6%, and 59.2% vs. 31.9%, P<0.01). There was no significant difference in survival rates of patients received radical mastectomy and modified radical mastectomy since 1980?蒺s (P>0.05). Of the 73 patients received breast conservative therapy, no local recurrence or metastasis occurred, with the maximal follow-up of 17 years. Of the patients in stage T2 -T4, the 5-, and 10-year survival rates were significantly higher in adjuvant chemotherapy group than in non-chemotherapy group (78.2% vs. 60.1%, and 48.9% vs. 30.7%, P<0.01). CONCLUSIONS: According to our data, breast cancer most frequently occurred in patients of 45-49 years old. TNM stage (especially the axillary lymph node status)relates to prognosis of breast cancer. The prognosis was worse in the patients with positive lymph node than in the patients with negative Lypmph node. The efficacy of modified radical mastectomy equals to that of radical mastectomy, breast conservative therapy can be applied to patients in early stage. Adjuvant chemotherapy and endocrine therapy can improve the survival of resectable breast cancer patients.