新辅助化疗联合保乳术治疗Ⅱ、Ⅲ期乳腺癌的效果观察

Observation of the efficacy of neoadjuvant chemotherapy combined with conserving-breast surgery in the treatment of patients with stage Ⅱ,Ⅲ breast cancer

目的 探讨Ⅱ、Ⅲ期乳腺癌患者经新辅助化疗联合保乳术治疗的有效性及安全性.方法 选取85例Ⅱ、Ⅲ期乳腺癌患者,分为保乳组与改良根治组,分别为42例及43例,保乳组术前使用新辅助化疗,而改良根治组未化疗,观察两组患者的疗效、随访结果等.结果 经过治疗后,保乳组的CR及PR例数共30例,有效率为71.4%,而改良根治组的CR及PR例数共21例,有效率为55.8%;两组差异有统计学意义（t=4.518,P=0.034）.根据乳房外形评价标准,34例患者为优,占80.9%;良为5例,占11.9%;差为2例,占4.8%,其优良率92.9%.根据患者自身对乳房外形进行判断,非常满意为37例,占88.1%;基本满意为3例,占7.1%;不满意为2例,占4.8%,满意率为95.2%.结论 Ⅱ、Ⅲ期乳腺癌患者保乳手术之前采取新辅助化疗可使临床分期降低,术后疗效及乳房外观均良好,具有重要的临床应用价值.

Objective To observe the efficacy and safety of neoadjuvant chemotherapy combined with conserving-breast surgery in treatment of patients with stage Ⅱ,Ⅲ breast cancer.Methods 85 patients with stage Ⅱ,Ⅲ breast cancer were selected,42 patients in breast-conserving group and 43 patients in modified radical group.Neoadjuvant chemotherapy was used in breast-conserving,while was not used in modified radical group.Efficacy and follow-up results were observed in the two groups.Results After treatment,the CR and PR in the breast-conserving group was 30 cases and the effective rate was 71.4%,which of the modified radical group was 55.8% with 21 patients of CR and PR.After the comparative analysis,the difference was statistically significant（t=4.518,P=0.034）.After followed for 12-36 months,the patients in the breast conserving group were all alive and one case of local recurrence.According to breast shape evaluation criteria,34 patients were excellent,accounting for 80.9%;good for the five cases,accounting for 11.9%;bad of two cases,accounting for 4.8% and the excellent rate was 92.9%.According to the patients＇ own judgment on the breast shape,37 cases were very satisfied,accounting for 88.1%;basic satisfaction for three cases,accounting for 7.1%;dissatisfied 2 cases,accounting for 4.8% and the satisfaction rate was 95.2%.Conclusion Patients with breast cancer of Ⅱ,Ⅲ period before breast-conserving surgery taking chemotherapy can reduce the clinical stage while the postoperative efficacy and breast appearance are good with important clinical value.