232例早期乳腺癌保乳治疗的中长期预后分析

Clinical analysis of mid-long term outcomes of 232 early breast cancer patients with breast-conserving treatment

目的评价早期乳腺癌保乳治疗的中、长期疗效。方法回顾性分析1999年1月1日至2005年12月31日接受保乳治疗的232例早期乳腺癌患者的临床特征、复发及生存资料。232例患者均接受肿块扩大切除或乳腺区段切除+腋窝淋巴结清扫术,术后根据情况行放疗、化疗、内分泌治疗等。结果中位随访时间为54个月,平均随访57.14个月(2～118个月)。局部复发3例,远处转移15例,死亡7例,1例局部复发后行乳房切除手术。发生远处转移的部位包括肺脏8例、肝脏5例、脑6例、骨8例。Kaplan-Meier生存分析显示,232例患者的3年、5年生存率分别为99.06%和96.98%,3年、5年无病生存率分别为97.01%和93.23%。171例肿瘤直径≤2cm患者的3年、5年生存率高于其余52例肿瘤直径>2cm者(P<0.05);141例接受内分泌治疗患者的3年、5年生存率高于52例未接受内分泌治疗者(P<0.05);腋窝淋巴结阳性患者的3年、5年无病生存率低于腋窝淋巴结阴性者(P<0.05)。结论在严格掌握保乳指征的前提下,早期乳腺癌病例进行保乳治疗安全可行。

Objective To evaluate the mid-long term outcomes of patients with early breast cancer who received breast-conserving treatment（BCT）.Methods The data of 232 early breast cancer patients,who received BCT in Cancer Hospital,Chinese Academy of Medical Sciences from January 1st,1999 to December 31st,2005,were collected and analyzed retrospectively.All the cases received extensive lumpectomy or quadrant resection plus axillary lymph nodes dissection,and then radiotherapy,chemotherapy or endocrinotherapy were arranged postoperatively according to the clinical features of patients.Results The median time of follow-up were 54 months and the mean time were 57.14 months（2-118 months）.Three cases got local recurrences;15 cases had distant metastases,and 7 cases died.One case received mastectomy because of local recurrence.As to the location of metastasis,8 cases were found in lungs,5 cases in livers,6 cases in brains and 8 cases in bones.Kaplan-Meier method showed the 3-year and 5-year overall survival rates were 99.06% and 96.98%,respectively.The 3-year and 5-year disease-free survival rates were 97.01% and 93.23%,respectively.The 3-,5-year overall survival rates of 52 patients with larger tumor（2cm） were lower than those of 171 patients with smaller tumor（≤2cm）,showing with significant differences（P0.05）,and the 3-,5-year overall survival rates of 52 patients without endocrinotherapy were significantly lower than those of 171 patients receiving endocrinotherapy（P0.05）.The 3-,5-year disease-free survival rates of lymph nodes positive patients were significantly lower than those of lymph nodes negative patients（P0.05）.Conclusion Conforming to the indication of breast conservation,BCT is safe and feasible for early breast cancer.