乳腺癌保乳治疗的临床研究

Clinical study of conservative surgery for early-stage breast cancer

目的探讨早期乳腺癌保乳综合治疗的疗效及可行性。方法将189例Ⅰ、Ⅱa期乳癌患者前瞻性非随机分为两组：（1）保乳组：92例行乳腺区段切除加腋窝淋巴结清扫术;（2）对照组：97例行乳癌改良根治术。两组术后均给予相同方案的放疗、化疗和内分泌治疗,术后进行定期随访,并进行美容评估。结果本组178例得到随访,随访率94.2%,中位随访时间为78个月。局部复发：保乳组3例,对照组1例。保乳组3年存活率97.7%,5年存活率94.1%,远处转移率7.9%。对照组3年存活率97.8%,5年存活率90.8%,远处转移率7.9%,两组局部复发和远处转移差异均没有统计学意义,两组3、5年生存率差异应用log-rank检验无统计学意义（P〉0.05）。COX比例风险模型分析发现年龄、ER、PR情况不是影响生存的风险因素,TNM分期与生存率有关。85.5%患者对保乳手术的美容效果满意。结论对早期乳癌使用保乳综合治疗可达到传统根治术相当的治疗效果,应作为早期乳癌的首选治疗方法。

Objective To discuss the therapeutic effect and feasibility of breast-conserving surgery in early stage breast cancer. Methods In this study, 189 patients of stage Ⅰ、Ⅱ a were divided into two groups non-randomly prospectively. In the breast-conserving surgery group, 92 patients of stage Ⅰ、Ⅱ a were treated with locally extensive tumor resection plus axillary lymphatic dissection ; The control group consisted of 97 cases of stage Ⅰ、Ⅱ a treated with modified radical mastectomy. Postoperatively all the patients in the two groups were treated with the same modality of radiotherapy, chemotherapy or endocrinotherapy. We carried out the follow-up in regular intervals, and estimated the cosmetic effect after breast-conserving therapy. Results One hundred and seventy-eight patients （94. 2% ） were followed up with average length of 78 months. Three patients had local recurrence in breast-conserving group and 1 patient had local recurrence in control group. The 3-and 5-year survival rate of breast-conserving group was 97. 8% and 94. 1% respectively, distant metastasic rate was 7.9% ; the 3- and 5-year survival rate of modified radical mastectomy group was 97.8% and 90. 8%, distant metastatic rate was 7.9%. The difference of survival rate, local recurrence and distant metastatic rate between the two groups was not significant, The difference of survival rate between the two groups was not significant by log-rank test （ P 〉 0. 05 ）. COX proportion risk model analysis found age, ER, PR condition was not the risk factor affecting survival, while TNM stages were correlated with the survival rate. 85.5% patients in breast-conserving group were satisfied for the cosmetic effect. Conclusion The therapeutic effect of breast-conserving therapy of early stage breast carcinoma patients is similar to that of modified radical mastectomy. Breast-conserving therapy should be the choice of therapy for early stage breast cancer.