保乳术联合表柔比星对乳腺癌术后乳房美容效果和雌激素受体蛋白表达的影响

Effect of breast-conserving surgery combined with epirubicin on cosmetic outcomes of breast and the expression of estrogen receptor protein

目的探讨保乳术联合表柔比星对乳腺癌患者术后乳房美容效果、临床疗效、雌激素受体(ER)α和ERβ蛋白表达的影响。方法选取2016年3月至2019年3月间上海市浦东新区公利医院收治的160例女性乳腺癌患者进行前瞻性研究,采用随机数字表法分为观察组和对照组,每组80例。观察组患者采用保乳术联合术前表柔比星新辅助化疗,对照组患者采用改良根治术治疗,比较两组患者手术指标、治疗前后ERα和ERβ表达水平、乳房美容效果、生存率、复发率及不良反应率。结果观察组患者手术引流量和术后拔管时间均优于对照组,差异均有统计学意义(均P<0.05)。治疗后,观察组患者ERα阳性率低于对照组,ERβ阳性率高于对照组,差异均有统计学意义(均P<0.05)。观察组患者乳房美容效果优良率为65.0%,高于对照组的0.0%,差异有统计学意义(P<0.05)。观察组患者3年生存率为96.3%(77例),对照组为92.5%(74例),观察组患者3年复发率为7.5%(6例),对照组为6.3%(5例),差异均无统计学意义(P>0.05)。两组患者不良反应以Ⅰ~Ⅱ度居多,对症治疗后均缓解。观察组患者各不良反应发生率均略高于对照组,但差异无统计学意义(P>0.05)。结论保乳术联合表柔比星治疗乳腺癌疗效确切,可降低ERα蛋白水平,提高ERβ蛋白水平,降低肿瘤复发率,维持乳房美容效果。

Objective To investigate the effect of breast-conserving combined with epirubicin on cosmetic outcomes of breast and the expression of estrogen receptor(ER)αand ERβprotein in breast cancer patients.Methods A prospective study was conducted in a total of 160 patients with breast cancer who received treatment at Shanghai Pudong New Area Gongli hospital between March 2016 and March 2019.They were randomly assigned to an observation group or a control group with 80 patients in each group using the random number table method.The observation group was given breast-conserving surgery combined with pre-operative neoadjuvant chemotherapy with epirubicin and the control group was given modified radical mastectomy.The operating index,expression of ERαand ERβbefore and after the treatment,cosmetic outcomes of breast,recurrence rate and adverse reactions were compared between the two groups.Results The surgical drain and extubation time was significant lower in the observation group than in the control group(P<0.05).The positive expression rate of ERαwas lower in the observation group than in the control group and negative expression rate was higher in the observation group than in the control group(all P<0.05).The fine/excellent rate of cosmetic outcomes was 65.0%in the observation group which was significantly higher than 0.0%of the control group(P<0.05).The 3-year survival was 96.3%(77)in the observation group and 92.5%(74)in the control group.The 3-year recurrence rate was 7.5%(6)in the observation group and 6.3%(5)in the control group(P>0.05).The most adverse reactions were gradeⅠtoⅡ,which were relieved after the symptomatic treatment.The incidence of adverse reactions slightly higher in the observation group than in the control group(P>0.05).Conclusion Breast-conserving combined with epirubicin in the treatment of breast cancer shows exact effectiveness.It helps to reduce the level of ERαprotein and improve the level of ERβprotein as well as reduce recurrence rate and maintain the cosmetic efficacy.