ⅠⅡ期乳腺癌单纯乳房切除并腋淋巴结清扫与根治术疗效比较(附192例随机对照研究)

The comparison between mastectomy plus axillary dissection and radical mastectomy in patients with ⅠandⅡstage breast cancer:follow-up of a randomized controlled study of 192 cases.

目的 前瞻性比较研究乳房切除并腋淋巴结清扫术 (MAD)与根治术 (RM )对Ⅰ、Ⅱ期乳腺癌的远期疗效。方法 将 192例Ⅰ、Ⅱ乳腺癌随机分两组 :MAD组 96例或加卵巢去势术 ;RM组 96例 ,或加卵巢去势术。MAD组腋淋巴结清除范围是腋下群淋巴结 ;RM组采用Halsted或仿根治Ⅱ式。卵巢去势是在乳房手术同时行双侧卵巢切除术。结果 MAD组和RM组 10年生存率分别为 80 4%和 81 8%;无病生存率分别为 76 7%和79 3%。局部复发率 :MAD组和RM组分别为 3 2 %和 2 3%。患侧上肢肿胀发生率 :MAD组和RM组分别为3 2 %和 7 9%。绝经前去势组 (36例 )与未去势组 (5 8例 ) 10年生存率分别为 79 4%和 81 4%,无病生存率分别为 74 7%和 74 9%。结论 对Ⅰ、Ⅱ期乳腺癌采用MAD的疗效与RM相同 ,且能改善病人的生存质量。

Objective To compare mastectomy plus axillary dissection with radical mastectomny in patients withⅠandⅡstage breast cancer. Methods One hundred and ninety-two women withⅠandⅡbreast cancer were randomly divided into two groups: one group with mastectomy and axillary dissection±ovariectomy (MAD group), another with radical mastectomy ±ovariectomy(RM group).Level-Ⅰlymph nodes in MAD group were cleared .Patients in RM group underwent Halsted radical mastectomy or modified radical mastectomy.Results Ten-year overall survival rates of MAD group and RM group were 80.4%and 81.8%, respectively.Ten-year disease-free survival rates were 76.7%and 79.3%,respectively.MAD group and RM group had the rates of 3.2%and 2.3% at local recurrence,respectively.The rates of upper limb edema was 3.2% in MAD group ,7^9% in RM group.Ten-year overall survival rates were 79.4%和81.4% in premenopausal patients with oophorectomy(36 cases) and without oophorectomy(58 cases),and 10-year disease-free survival rates were 74.7% and 74.9% in those groups,respectively.Conclusion Mastectomy plus axillary dissection has the same effect as radical mastectomy on patients with ⅠandⅡstage breast cancer. Moreover, it improves the patients’quality of life.