保留皮肤的青年乳腺癌改良根治术后即刻乳房再造与改良根治术的比较分析

Comparative analysis of immediate breast reconstruction after skin-sparing mastectomy and modified radical mastectomy in young breast cancer patients

目的：比较保留皮肤的乳腺癌改良根治术后即刻乳房再造与改良根治术对青年患者的疗效，并对乳房再造患者的预后因素进行分析。方法：回顾性分析柳州市人民医院2008年7月至2014年6月收治并行保留皮肤的乳腺癌改良根治术后即刻乳房再造组（60例）与改良根治术组（68例）的青年乳腺癌患者临床病理资料，比较两组间局部复发、无瘤生存及总生存，并分析年龄、肿瘤大小、是否保留乳头乳晕等因素对乳房再造患者生存的影响。结果：所有病例随访15～88个月，中位时间51个月。即刻乳房再造组局部复发3例，远处转移8例，死亡5例，3年无瘤生存率91．7％，5年无瘤生存率81．7％，总生存率91．7％；改良根治术组局部复发2例，远处转移9例，死亡5例，3年无瘤生存率94．1％，5年无瘤生存率83．8％，总生存率92．6％，两组比较均差异无统计学意义（均P〉O．05）。即刚乳房再造组患者预后分析显示，淋巴结转移及雌孕激素受体阴性与无瘤生存率、总生存率相关（均P〈0．05）。结论：青年乳腺癌患者保留皮肤的改良根治术后即刻乳房再造组与改良根治术组在局部复发及远期生存方面无显著性差异，对于早期青年乳腺癌患者是安全的，保留乳头乳晕并未增加肿瘤复发风险，淋巴结转移及雌孕激素受体阴性是影响顸后的主要因素。

Objective： To compare the therapeutic effects between immediate breast reconstruction （IBR） after skin-sparing mastecto- my and modified radical mastectomy （MRM） in young breast cancer patients （≤35 years）, as well as to analyze the prognostic factors of IBR in these patients. Methods： The clinicopathological data of young breast cancer patients who had undergone IBR after skin-spar- ing mastectomy （60 cases） and MRM （68 cases） in Liuzhou People＇s Hospital from July 2008 to June 2014 were retrospectively ana- lyzed. Local recurrence, disease-free survival, and overall survival of the patients between the two groups were compared. The influ- encing factors for survival of the IBR group patients, such as age, tumor size, and nipple-areolar complex preservation, were analyzed. Results： All patients were followed-up for a period ranging from 15 to 88 months with a median of 51. In the IBR group, local recur- rence, distant metastasis, and death occurred in 3, 8, and 5 cases, respectively. The 3- and S-year disease-free survival rates （DFSR} were 91.7% and 82.7%, respectively, whereas the overall survival rate （OSR） was 91.7%. In the MRM group, local recurrence, distant metastasis, and death occurred in 2, 9, and 5 cases, respectively. The 3- and 5-year DFSRs were 94.1% and 83.8%, respectively, where- as the OSR was 92.6%. No statistical difference was noted between the two groups （P〉O.O5）. The analysis of prognostic correlation fac- tors in the IBR group patients shows that lymph node metastasis and estrogen and progesterone receptor-negative correlated with the tumor-free survival and overall survival rates （P〈0.05）. Conclusion： No apparent statistical difference in the comparison of the local re- currence and long-term survival rate was observed between the two groups＇ young breast cancer patients who underwent IBR after skin-sparing mastectomy and MRM. IBR after skin-sparing mastectomy is safe for young breast cancer patients with early-stage, and nipple-areolar complex preservation does not increase the risk of recurrence in the IBR group patients. Lymph node metastasis and es- trogen and progesterone receptor-negative are the major prognostic factors of IBR after skin-sparing mastectomy in young breast can- cer patients.