新辅助化疗联合保乳手术在中晚期乳腺癌中临床疗效的分析

Clinical efficacy of neoadjuvant chemotherapy plus breastconserving surgery in middle-advanced breast cancer

目的:探讨新辅助化疗联合保乳手术在中晚期乳腺癌治疗中的临床疗效及应用价值。方法:回顾性分析2008年2月—2010年2月收治的II～III期乳腺癌97例的临床资料,其中新辅助化疗联合保乳手术41例(保乳组,术前行新辅助化疗)和改良根治术56例(改良根治组,术前未行化疗),对两组临床疗效进行评估。结果:保乳组客观缓解率高于改良根治组(73.17%vs.57.14%,P<0.05)。经23.2个月中位随访,保乳组全部存活,局部复发1例,未发生远处转移;改良根治组局部复发6例,5例发生远处转移,其中3例死亡;保乳组与改良根治组中位无进展生存期分别为32.3个月和22.1个月(P<0.05)。保乳组乳房外形评价82.93%为优;患者美观满意度90.24%为非常满意,7.32%为基本满意。结论:保乳术前辅助化疗可明显使中晚期乳腺癌临床分期降低,且术后近期疗效和美观效果均好,这对部分中晚期患者来说具有重要临床价值。

Objective： To investigate the clinical efficacy and application value of neoadjuvant chemotherapy plus breast- conserving surgery for middle-advanced stage breast cancer. Methods： The clinical data of 97 patients with stage II-III breast cancer treated from February 2008 to February 2010 were retrospectively analyzed. Of the patients, 41 cases received neoadjuvant chemotherapy plus breast-conserving surgery （breast-conserving group, patients undergoing neoadjuvant chemotherapy before surgery） and 56 cases were subjected to modified radical mastectomy （modified radical surgery group, patients undergoing no chemotherapy before surgery）. ~ihe clinical efficacies between the two groups were compared. Results： The objective response rate in breast-conserving group was significantly higher than that in modified radical surgery group （73.17% vs. 57.14%, P〈0.05）. After the follow-up period of a median of 23.2 months, patients in breast-conserving surgery group all survived, with one case of local recurrence and no distant metastasis; in modified radical surgery group, local recurrence occurred in 6 cases and distant metastasis occurred in S cases, 3 cases of whom died. The median progression-free survival in breast-conserving group and modified radical surgery group was 32.3 and 22.1 months, respectively （P〈0.0S）. In breast-conserving surgery group, cosmetic evaluation of breast appearance for 82.93% cases was excellent, subjective cosmetic satisfaction in 90.24% cases was very satisfied and in 7.32% cases was satisfied. Conclusion： Neoadjuvant chemotherapy can remarkably decrease the clinical stage of middle-advanced stage breast cancer before breast-conserving surger）5 and the short-term postoperative efficacy and cosmetic results are all satisfactor）5 with important clinical benefits for some of these patents.