乳腺癌行麦默通微创旋切术后肿瘤残留情况的影响因素分析

Analysis of influencing factors of residual tumor of breast cancer after Mammotome surgery

目的探讨乳腺癌行麦默通微创旋切术后肿瘤残留的影响因素。方法选择接受麦默通微创旋切术的63例乳腺癌患者,根据再次手术后的病理结果评估肿瘤残留情况,并将患者分为肿瘤残留组和无肿瘤残留组。比较两组患者再次手术前的基线特征以及再次手术后的临床特征和治疗情况。采用Kaplan-Meier法绘制生存曲线,比较两组患者的总生存情况和无病生存情况。结果63例患者中,40例患者接受乳房切除术(3例为全切术后即刻重建),23例患者接受保乳手术;其中44例患者于麦默通旋切术后有肿瘤残留,残瘤率为69.84%。肿瘤残留组(n=44)和无肿瘤残留组(n=19)患者的年龄、旋切前肿瘤乳腺影像报告与数据系统(BI-RADS)分级、旋切肿瘤最大直径、旋切部分组织学类型及组织学分级比较,差异均无统计学意义(P﹥0.05);两组患者旋切后超声病变最大径、形态、血流情况比较,差异均有统计学意义(P﹤0.05)。再次手术后,两组患者的肿瘤T分期比较,差异有统计学意义(P﹤0.05);两组患者的肿瘤总分期比较,差异无统计学意义(P﹥0.05);两组患者的内分泌治疗、化疗、放疗及靶向治疗情况比较,差异均无统计学意义(P﹥0.05)。两组患者的总生存情况及无病生存情况比较,差异均无统计学意义(P﹥0.05)。结论麦默通微创旋切系统在乳腺癌诊疗中存在一定的肿瘤残留,如术前高度怀疑乳腺病变为恶性,且经麦默通旋切活检确诊为乳腺癌,应考虑二次手术以确保瘤腔无肿瘤残留。

Objective To investigate the influencing factors of residual tumor of breast cancer after Mammotome surgery.Method 63 patients with breast cancer were enrolled after receiving Mammotome surgery and had confirmed malignancy on pathological diagnosis.All patients were divided into tumor residual group and non-tumor residual group according to the tumor residual status after reoperation.The baseline characteristics before reoperation and the clinical records and treatment options after reoperation were compared between the two groups.The Kaplan-Meier method was used to compare the overall survival and disease-free survival of the two groups.Result Among the 63 patients,40 patients received mastectomy(3 cases were immediately reconstructed after breast resection),and 23 patients underwent breast-conserving surgery.Residual tumor was detected for 44 of the 63 patients(69.84%).There were no significant differences in age of patients,breast imaging-reporting and data system(BI-RADS)classification of the tumors before Mammotome,maximum diameter of the resected tumors,histological type and grade of the resected tumors between the tumor residual group(n=44)and the non-tumor residual group(n=19)(P>0.05).There were statistically significant differences in the ultrasound maximum diameter,morphology and blood flow of the lesions after Mammotome between the two groups(P<0.05).After reoperation,there was significant difference in T staging between the two groups(P<0.05);there was no significant difference between the two groups in terms of total tumor staging,whether they received endocrine therapy,chemotherapy,radiotherapy and targeted therapy,as well as overall survival and disease-free survival(P>0.05).Conclusion There existed certain residual tumor in the application of Mammotome surgery in breast cancer.If a breast lesion is highly suspected of cancer after preoperative examinations,and diagnosed as breast cancer after Mammotome biopsy,secondary surgery should be considered to ensure that there are no tumor residues.