680例乳腺癌保留乳房治疗的远期疗效分析

Long-term results breast-conserved of therapy for breast cancer

目的探讨对临床Ⅰ、Ⅱ期乳腺癌患者选择性行乳腺癌保留乳房治疗(BCT)的远期生存、同侧乳房复发(IBR)、美容效果及其相关因素。方法1985年10月至2007年12月共对680例临床Ⅰ、Ⅱ期乳腺癌开展BCT临床研究。乳腺癌保乳手术先后采用乳腺象限/区段切除术及肿瘤扩大切除术,联合全腋淋巴结清扫术或前哨淋巴结活检术。术后放疗先后采用Co60及加速器全乳放疗及瘤床缩野照射。结果中位随访10年,680例BCT患者10年总生存率IBR83.7%、同侧乳房复发为8.5%、远处转移率为23.7%。患者年龄、肿瘤大小、病理组织学类型、腋淋巴结转移状况等临床病理因素对BCT后IBR差异无统计学意义(均P>0.05);切缘阳性、术后未行全乳照射的患者IBR显著升高(均P=0.000)。在确保切缘阴性的前提下,不同切除范围的手术方式对IBR差异无统计学意义(P=0.799),但切除范围较大的区段/象限切除术对BCT后乳房美容效果差异有统计学意义(优秀组P=0.043,优秀+良好组P=0.005)。结论临床Ⅰ、Ⅱ期乳腺癌选择性行BCT有较好的远期疗效、较好的美容效果和较低的IBR,可以安全地替代乳房切除性手术;确保切缘阴性及接受术后全乳放疗仍是现阶段乳腺癌BCT的金标准;在确保切缘阴性的前提下,切除范围较小的肿瘤扩大切除术有较好的美容效果和相同的治疗效果。

Objective To evaluate the survival, ipsilateral breast recurrence （IBR） and cosmetic results of breast conserved therapy （BCT） for stage Ⅰ and Ⅱ breast cancer. Methods From Oct. 1985 to Dec. 2007, BCT was performed in 680 patients with stage Ⅰ and Ⅱ breast cancer. Breast conserved surgery included quadrantectomy, sector resection, and lumpectomy, combined with whole axillary lymph node dissection. Co^60 and accelerator were used for whole breast and boast irradiation. Results With median follow up of 10 years, the overall survival, IBR, and distant recurrence rates were 83.7%, 8.5%, and 23.7% , respectively. Patient age, tumor size, histopathological type, and axillary node status had no relatunship with IBR （ P 〉 0.05 ）, IBR was significant higher in patients with positive margin and without irradiation （P = 0. 000 for both）. With a clear margin, there was no difference of IBR between quadrantectomy/sector resection and lumpectomy （P =0.799）, but the former had poor cosmetic results （P 〈 0.05 ）. Conclusions With excellent long-term survival, IBR, and cosmetic results, BCT could safely replace mastectomy in patients with stage Ⅰ and Ⅱ breast cancer; Clear margin and whole breast irradiation are still gold standards for BCT at present; Lumpectomy has better cosmetic results and same curative effect compared to quadrantectomy/sector resection.