保留乳头乳晕复合体的改良根治术治疗早期乳腺癌患者疗效分析

Efficacy of modified radical operation of preserving nipple-areolar complex on early stage breast cancer

背景与目的:保留乳头乳晕复合体(nipple-areolar complex,NAC)对乳腺癌患者乳房重建的美容效果和术后生活质量有重要意义。但保留NAC改良根治术治疗早期(Ⅰ、Ⅱa期)乳腺癌的肿瘤学风险一直存在着争论。本研究比较保留NAC的改良根治术与传统改良根治性手术治疗早期乳腺癌疗效。方法:在1998年1月～2003年12月间在我院接受手术的早期乳腺癌患者中,根据发病年龄、腋窝淋巴结状态、激素受体情况、肿块大小和Her-2/neu的表达状态5个变量对42例接受保留NAC改良根治术患者和84例接受传统改良根治术患者的按1∶2比例进行配对的回顾性队列研究。比较两组的局部区域复发率、远处转移率、总生存率和无瘤生存率。结果:保留NAC组中位随访时间为48个月,传统改良根治组为44个月。保留NAC组5年局部区域复发率为2.44%,传统改良根治组3.21%,两者差异无统计学意义(P=0.771)。保留NAC组5年远处转移率为5.64%,传统改良根治组为4.30%,两者差异无统计学意义(P=0.654)。保留NAC组和传统改良根治组5年总生存率分别为96.00%和98.18%,差异无统计学意义(P=0.694);5年无瘤生存率分别为91.67%和92.26%,差异无统计学意义(P=0.597)。结论:在严格把握适应症基础上行保留NAC改良根治术治疗早期乳腺癌可以和传统的改良根治术取得相似的治疗效果,但可以增强患者乳房重建的美容效果和提高术后生活质量。

Background and Objective： Modified radical mastectomy of preserving nipple-areolar complex （NAC） is an important surgical therapy for stage I-Ila breast cancer, but the oncological risk is controversial. This study was to compare the efficacy of NAC-preserving modified radical operation and conventional modified radical operation on early stage breast cancer. Methods.. The patients who received NAC-preserving modified radical operation （42 patients） or conventional modified radical operation （84 patients） from January 1998 to December 2003 in the First Affiliated Hospital of Bengbu Medical College were matched with a ratio of 1：2 by age at diagnosis, axillary lymph node status, sexual hormone receptor status, tumor size and Her-2/neu expression for retrospective analysis. The Iocoregional recurrence, distant metastasis, 5-year disease-free survival （DFS） and 5-year overall survival （OS） between the two groups were compared. Results： Median follow-up time was 48 months in NAC-preserving operation group and 44 months in conventional operation group. The 5-year occurrence rate of Ioco-regional recurrence was 2.44% in NAC-preserving operation group and 3.21% in conventional operation group （P = 0.771）. The 5-year occurrence rate of distant metastasis was 5.64% in NAC-preserving operation group and 4.30% in conventional operation group （P = 0.654）. The 5-year OS rates were 96.00% in NAC-preserving operation group and 98.18% in conventional operation group （P=0.694）. The 5-year DFS rates were 91.67% in NAC-preserving operation group and 92.26% in conventional operation group （P=0.597）. Conclusion： Modified NAC-preserving radical operation results in the same effect on early stage breast cancer as conventional modified radical operation based on careful consideration of the indications, and results in better cosmetic appearance after restitution and better quality of life.