早期乳腺癌患者行乳房保留手术的疗效分析

Efficacy of Breast Conservative Surgery in Patients with Early-Stage Breast Cancer

目的:探讨早期乳腺癌患者行乳房保留手术(保乳手术)的疗效及预后的相关因素。方法:回顾分析326例行保乳手术的早期女性乳腺癌患者(研究组)的临床资料,以同期行改良根治术或单纯乳房切除术的581例早期女性乳腺癌患者作为对照(对照组)。结果:研究组的3年和5年无病生存率(disease free survival,DFS)分别为92.7%和84.5%,对照组则分别为91.4%和85.3%。研究组的3年和5年总生存率(overall survival,OS)分别为98.2%和96.4%,对照组则分别为97.6%和95.3%。两组的DFS和OS均无统计学差异(P>0.05)。研究组中脉管无癌栓患者的3年和5年DFS分别为94.5%和92.1%,而脉管有癌栓患者的3年和5年DFS分别为90.2%和81.3%,两者的差异有统计学意义(P=0.007)。研究组患者中复发12例,其中>40岁的239例中复发5例,而≤40岁的87例中复发7例,两者的差异有统计学意义(P=0.032)。脉管无癌栓的278例患者中复发7例,脉管有癌栓的48例患者中复发5例,两者的差异有统计学意义(P=0.014)。保乳手术后的美容效果评价优良率为87.4%。结论:对于早期乳腺癌患者,行保乳手术与行传统的乳房切除手术的预后无显著差异,脉管癌栓与保乳手术的预后相关,年龄≤40岁的患者保乳术后局部复发率较高。

Objective：To investigate the curative effects of breast conservative surgery in patients with early-stage breast canc- er and the factors related with prognosis. Methods： The clinical data of 326 female patients with early-stage breast cancer under- going breast conservative surgery（study group） was reviewed. Another 581 female patients with early-stage breast cancer un- dergoing mastectomy surgery during the same period were also enrolled（control group）. Results： The 3- year disease-free sur- vival（DFS） rate and 5-year DFS rate were 92.7% and 84.5%in the study group,and those were 91.4%and 85.3% in the con- trol group. The 3-year overall survival （OS） rate and 5-year OS rate were 98.2% and 96.4% in the study group, and those were 97.6% and 95.3%in the study group. There was no significant difference in the DFS rates and OS rates between the two groups （P〉0.05）. In the study group, the 3-year OS rate and 5-year OS rate were 94.5% and 92.1% for the patients without cancer embotuses in lymph vessels and blood vessels, and those were 90.2% and 81.3%for the patients with cancer emboluses in lymph vessels and blood vessels （P = 0. 007）. There were 12 cases of in ipsilateral breast tumor recurrence （IBTR） in the study group. There were 5 cases of recurrence among the 239 patients older than 40 years in the study group, while there were 7 cases of recurrence among the 87 patients younger than 40 years（P = 0. 032）. In the 278 cases without cancer emboluses in lymph vessels and blood vessels, there were 7 cases of recurrence, while in the 48 cases with cancer emboluses in lymph vessels and blood vessels, there were 5 cases of recurrence（P = 0. 014）. The cosmetic results were excellent and good in 87.4%of the cases in the study group. Conclusions： The OS rate of the early-stage breast cancer patients treated with breast conservative surgery have no significant difference with that of early-stage breast cancer patients treated with mastectomy. The cancer embo- luses in lymph vessels and blood vessels is a prognostic factor of the breast conservative surgery. And younger patients have more chance of recurrence.