Auchincloss术治疗进展期乳腺癌的Rotter淋巴结与近期疗效分析

Autincloss Treatment of Rotter Lymph Nodes in Advanced Breast Cancer and Analysis of the Short-term Curative Effect

目的分析进展期乳腺癌患者行保留胸大、小肌的乳腺根治切除加腋窝淋巴结清扫,即Auchincloss术,对胸肌间(Rotter)淋巴结阳性作为观察组和阴性对照组比较,评价乳腺癌Auchincloss术后Rotter’s淋巴结阳性率及其临床意义。方法回顾性分析该院自2010年1月—2017年12月收治的进展期乳腺癌改良根治性切除的行Auchincloss术患者164例,术后标本淋巴结有无伴有胸大小肌间Rotter淋巴结转移,将其分为A组(阳性组)、B组(阴性对照组)。比较两组术后生活质量和生存率差异性。结果 A组:手术时间(116±15)min,手术出血量(50±6)mL,腋淋巴结送检数(16±3)枚,住院时间(18±2)d,住院费用(1.3±0.2)万元。术后腋淋巴结标本阳性29例,皮瓣坏死3例,皮瓣下积液1例,患肢水肿1例,胸肌萎缩2例,患肢抬举困难1例。ER阳性4例,PR阳性3例,LuminalA型4例,LuminalB型12例,HER-2(+++)13例,复发4例,3年内死亡2例。B组:手术时间(100±10)min,手术出血量(49±5)mL,腋淋巴结送检数(13±2)枚,住院时间(17±1)d,住院费用(1.2±0.2)万元,术后腋淋巴结标本阳性38例,皮瓣坏死11例,皮瓣下积液4例,患肢水肿2例,胸肌萎缩1例,患肢抬举困难4例,ER阳性43例,PR阳性39例,LuminalA型53例,LuminalB型34例,HER-2(+++)12例,复发1例,无3年内死亡。两组在皮瓣坏死、皮瓣下积液、患肢水肿、胸肌萎缩、患肢抬举困难、手术出血量、住院天数、住院费用等,差异无统计学意义(χ~2=0.00,0.24,0.01,2.06,0.24,t=0.95,3.99,1.73,P>0.05)。两组在手术时间、腋淋巴结数和阳性率、ER、PR阳性率,LuminalA型、HER-2(+++)、复发率、3年死亡率等方面,差异有统计学意义(t=7.16,6.71,χ~2=47.33,4.22,4.70,7.43,19.84,9.23,4.26,P<0.05)。结论乳腺癌改良根治Auchincloss手术后胸肌间Rotter淋巴结阳性,伴有腋淋巴结转移,ER、PR阳性率低、HER-2过表达,分子分型LuminalA型少,术后病理分期pTNM级别高危、及预后不良,并影响其生存率。

Objective To analyze the breast cancer patients who underwent radical mastectomy and small muscle resection and axillaty lymph node dissection, ie Auchincloss, and compare the breast muscle （Rotter） lymph node positive as observation group and negative control group to evaluate breast cancer, and the positive rate of Rotter＇s lymph nodes after Auchincloss and its clinical significance. Methods A retrospective analysis of 164 patients with Auchincloss who underwent modi- fied radical resection of advanced breast cancer from Januaty 2010 to December 2017 in the hospital. The postoperative specimens with lymph nodes were associated with chest-sized intermuscular Rotter lymph nodes transfer, divided into group A（positive group）, group B （negative control group）. The differences in quality of life and survival between the two groups were compared. Results Group A： operation time （116±15）min, surgical bleeding volume （50±6）mL, axillaty lymph node delivery （16±3）, hospitalization time （18±2）days, hospitalization cost （1.3±0.2）million, respectively. Postoperative axillaty lymph node specimens were positive in 29 eases, flap necrosis in 3 eases, subcutaneous effusion in 1 ease, limb edema in 1 ease, chest muscle atrophy in 2 eases, and limb lift difficulty in 1 ease. There were 4 eases of ER positive, 3 eases of PR positive, 4 eases of Luminal type A, 12 eases of Luminal type B, 13 eases of HER-2 （＋＋＋）, 4 eases of recurrence, 2 eases of death within 3 years. Group B： operation time （100±10）min, surgical bleeding volume （49＋5）mL, axillary lymph node delivery count （ 13±2）, hospitalization time （ 17±1 ） days, hospitalization cost （ 1.2±0.2）million, postoperative axillary lymph node specimen positive 38 cases, there were 11 cases of skin flap necrosis, 4 cases of subcutaneous effusion, 2 cases of limb edema, 1 case of chest muscle atrophy, 4 cases of limb lift difficulty, 43 cases of ER positive, 39 cases of PR positive, 53 cases of Luminal type A, Luminal type B. Of the 34 patients, 12 had HER-2 （＋＋＋） and 1 had reeurrence, and died within 3 years. There were no significant differences between the two groups in flap necrosis, effusion under the skin flap, edema of the affected limb, chest muscle atrophy, diffieulty in lifting the limb, amount of surgical bleeding, length of hospital stay, and hospitalization expenses（X^2=0.00,0.24,0.01,2.06,0.24 ,t=0.95,3.99,1.73 ,P〉0.05）. The operation time, axillary lymph node number and positive rate, ER, PR positive rate, Luminal A type, HER-2 （＋＋＋）, recurrence rate, and 3-year mortality were statistically significant （t=7.16,6.71, X^2=47.33,4.22,4.70,7.43,19.84,9.23,4.26,P〈0.05）. Conclusion Modified Auchincloss in breast cancer is positive for Ritter lymph node, with axillary lymph node metastasis, low positive rate of ER and PR, overexpression of HER-2, less molecular type Luminal A, high risk of postoperative pathological stage pTNM, and prognosis bad and affects its survival rate.