乳腺癌改良根治术后胸膜转移的临床分析

Clinical analysis of postoperative pleural metastasis in breast cancer patients treated with modified radical mastectomy

目的:探讨乳腺癌改良根治术(modified radical mastectomy,MRM)前不同原发肿瘤直径、术后腋窝淋巴结转移、术后治疗在术后发现胸膜转移及转移后死亡时间的差异。方法:132例既往行改良根治术后发现胸膜转移的女性乳腺癌患者,按术后腋窝淋巴结转移情况分为阴性组13例,1-3枚组20例,4-6枚组34例,7-14枚组38例,全部转移组27例;按原发肿瘤直径(以最大长径表示)分为<2.0cm组20例,2.0-5.0cm组73例,>5.0cm,<7.0cm组39例;按术后治疗方式分为常规化疗组65例,常规化疗联合三苯氧胺(tamoxifen,TAM)组67例。观察术后发现胸膜转移、转移后死亡的月数和不同月数段上的病例数。结果:术后发现胸膜转移的月数平均为33.57个月,转移至死亡月数平均为15.64个月。阴性组、原发肿瘤直径<2.0cm组、常规化疗联合TAM组术后胸膜转移、转移后生存时间较长,与其它各组比较有显著性差异(P<0.05或P<0.01),且原发肿瘤直径越大发生术后胸膜转移和转移后死亡时间,以及腋窝淋巴结转移数目越多发生术后胸膜转移的时间有缩短趋势。结论:术前腋窝淋巴结转移数目、原发肿瘤直径与乳腺癌患者改良根治术后胸膜转移时间及转移后死亡时间有关。早期手术、术后综合治疗仍是最大程度预防胸膜转移的重要措施。

Objective：To explore the differences of different primary tumor diameter before the modified radical mastectomy （MRM）,axillary lymph node metastasis,and postoperative treatment in postoperative pleural metastasis and transfer time of death.Methods：Of 132 female patients with breast cancer treated with MRM before were observed,13 cases were negative group,20 cases were 1 to 3 group,34 cases were 4 to 6 group,38 cases were 7 to 14group,27 cases were all transfer group according to number of postoperative axillary lymph node metastasis.20 cases were ＜2.0cm group,73 cases were 2.0cm to 5.0cm group,39 cases were ＞5.0cm,＜7.0cm group according to initial tumor diameter （longest diameter）.65 cases were conventional chemotherapy group,67 cases were conventional chemotherapy and tamoxifen （TAM） group according to post-operative treatment.Results：The average number of months was 33.57 months after surgery in pleural metastasis.The average number of months was 15.64 months in the transfer to the death.The time of postoperative pleural metastasis and death transferred was more in negative group,＜2.0cm group,conventional chemotherapy and TAM group （P ＜0.05 or P ＜0.01）.The time of pleural metastasis and death transferred gradually shortened with larger initial tumor diameter,and time of death transferred gradually shortened with more preoperative axillary lymph node metastases.Conclusion：There is a correlation between the number of preoperative axillary lymph node metastasis and initial tumor diameter in breast cancer patients before surgery with postoperative pleural metastasis and death transferred.Early surgery,postoperative treatment is still important measure to prevent pleural metastasis.