乳腺癌保乳手术治疗148例分析

目的研究乳腺癌保乳治疗方法的选择,探讨保乳手术适应证及疗效. 方法回顾分析1996年1月～2003年10月我院接受保乳治疗的148例乳腺癌临床资料.0期5例,Ⅰ期85例,Ⅱ期55例,Ⅲ期3例.手术方式为象限切除或肿块局部广泛切除联合腋窝淋巴结清扫.术后常规行辅助放疗、化疗和内分泌治疗. 结果手术标本石蜡病理检查各切缘均无癌浸润.经过54个月中位随访期(范围2～84个月),局部复发率为2.7%(4/148),其中乳腺3例,腋窝1例;远处转移率3.4%(5/148),手术至远处转移间期6～43个月,转移部位分别为肺、肝、脑膜和骨,其中3例死亡.对保乳综合治疗结束后满1年的108例患者进行乳房外形的评估,优32.4%(35/108),良49.1%(53/108),差18.5%(20/108). 结论对早期乳腺癌及部分经新辅助化疗降期后的局部进展期乳腺癌进行保乳手术治疗效果满意.规范化的切除和术后放疗、全身综合治疗是保乳治疗成功的关键.保乳手术后大部分患者乳房外形良好.     

Ⅱ期和ⅢA期可手术乳腺癌新辅助化疗的疗效观察

目的 探讨Ⅱ期和ⅢA期(仅指T3N1M0)可手术乳腺癌新辅助化疗的效果,评价新辅助化疗在Ⅱ、ⅢA期乳腺癌治疗中的价值;初步探讨肿瘤大小与病理完全缓解的关系;初步分析新辅助化疗的应用选择.方法 回顾分析北京友谊医院普外科收治的可手术乳腺癌临床病例共408例,分为A组(新辅助化疗组)及B组(对照组),A组Ⅱ期106例、ⅢA期112例,B组Ⅱ期92例、ⅢA期98例,A组应用新辅助化疗4个周期,随后进行手术,术后辅助化疗、放疗.B组不做任何形式的术前辅助治疗,手术和术后其他治疗与A组相同,比较两组的近期疗效、术式选择、局部控制率和5年生存率.结果 A组Ⅱ期可保乳率由23.6％提高到49.1％ (P=0.000),两组Ⅱ期5年总生存率和无瘤生存率差异无统计学意义(P =0.939、0.858);A组ⅢA期患者5年总生存率(59.8％)和无瘤生存率(51.8％),均高于B组(35.7％、27.6％)(P=0.000、0.000);3年局部复发转移率A组(7.9％)低于B组(18.4％)(P＜0.05);肿瘤小于3.0 cm易达到病理完全缓解(P =0.001),预后情况好(P=0.000).结论 新辅助化疗可提高Ⅱ、ⅢA期可手术乳腺癌患者的保乳率、降低局部复发转移率;可提高ⅢA期乳腺癌患者的5年生存率;新辅助化疗能达到临床和病理完全缓解患者5年总生存率和无瘤生存率更高;肿瘤大小是影响乳腺癌新辅助化疗病理完全缓解的独立因素,病灶小易达到完全缓解.     

局部晚期乳腺癌有效新辅助化疗后病灶的病理表现及保乳可行性分析

目的 探讨局部晚期乳腺癌经新辅助化疗后病灶消退的病理表现及肿块缩小后保乳手术的可行性.方法 回顾分析2003年6月至2007年8月46例有效的新辅助化疗后手术的乳腺癌患者的临床资料.患者均为女性,年龄28～65岁,平均46.3岁,肿瘤最大径7～13 cm.所有病例均在新辅助化疗后行乳腺癌改良根治术或标准根治术,术后对切除标本以残余肿瘤为中心行6个不同方向的连续切片,评价肿瘤的消退情况.结果 全组41.3%(19/46)肿瘤呈向心性缩小,其中31.6%(6/19)肿瘤向心性缩小并且周围无癌灶残留,68.4%(13/19)肿瘤向心性缩小但周围仍有癌灶残留.全组58.7%(27/46)肿瘤呈筛状消退.结论 局部晚期乳腺癌经新辅助化疗有效的大部分患者病理表现仍未达到保乳要求,保乳手术应慎重.     

乳腺

乳腺癌保乳根治术后同时进行辅助放疗和化疗的副反应的临床观察；乳腺癌前哨淋巴结定位切除、微转移检测及其临床意义；胸腔镜内乳前哨淋巴结活检和内乳淋巴链切除的实验研究；局部进展期乳腺癌新辅助化疗后保乳手术31例报告；瘦素及瘦素受体在乳腺癌中的表达及临床意义……[编者按]     

NCT联合NET在绝经后乳腺癌患者中的应用

目的评价新辅助化疗联合新辅助内分泌治疗对绝经后、ER(+)乳腺癌的近期疗效及与受体的相关性。方法 40例绝经后乳腺癌,给予FEC方案新辅助化疗联合速莱方案新辅助内分泌治疗,治疗时间8周。结果 40例患者,完全缓解4例(10%),部分缓解14例(35%),轻度缓解21例(52.5%),无变化1例(2.5%),进展0例(0%)。其中ER和PR双阳性的为27例,完全缓解3例(11.1%),部分缓解11例(40.7%),轻度缓解13例(48.1%);单独ER阳性的13例,完全缓解1例(7.7%),部分缓解3例(23.1%),轻度缓解8例(61.5%),无变化1例(7.7%);两组疗效比较,差异有统计学意义(P0.01)。40例患者经8周新辅助化疗联合新辅助内分泌治疗后,均接受手术治疗,其中5例行保乳手术,31例行乳腺癌改良根治术,4例行经典根治术治疗,术后继续相关辅助治疗。结论绝经后、ER(+)乳腺癌患者采用FEC方案新辅助化疗联合速莱方案新辅助内分泌治疗有效、安全、可靠,为缩小手术切除术式创造了条件。     

Ⅲ、Ⅳ期胃癌新辅助化疗后再手术疗效的临床研究

目的:观察难以一期切除的Ⅲ、Ⅳ期胃癌行术前新辅助化疗后再手术的临床疗效,评价术前新辅助化疗在Ⅲ、Ⅳ期胃癌中的治疗作用。方法:总结1991年10月～2002年6月间82例Ⅲ、Ⅳ期胃癌,其中Ⅲa期12例,Ⅲb33例,Ⅳ期37例。入院后经B超和CT检查,术前评估病灶难以一期根治性切除者进行2次以上的介入治疗,再行CT复查,对比后进行手术治疗,术后均行综合治疗。结果:肿瘤明显缩小者59例(72%),肿瘤切除率为74%,获得根性根治切除术者42例(51%)。无手术死亡率,并发症发生率为13.4%。1年生存率75.6%(59/78),3年54.8%(23/42),5年36.4%(8/22)。结论:对术前评估难以一期切除的晚期胃癌,作新辅助化疗后再行手术治疗,可以提高手术切除率和治愈率。     

局部进展期乳腺癌新辅助化疗后保乳治疗的疗效观察

目的:探讨局部进展期乳腺癌新辅助化疗后保乳治疗的可行性及疗效.方法:对2006年2月-2009年3月62例Ⅱ,Ⅲ期乳腺癌患者给予CET方案化疗4～6周期后评估符合保乳条件行保乳治疗.分析新辅助化疗有效率及保乳术后的局部复发率、远处转移率、术后乳房美容效果等.结果:新辅助化疗有效率88.7％.符合保乳条件50例(80.6％,50/62).实际48例保乳成功.经40～81个月随访,同侧乳房复发率4.16％,远处转移率8.33％,乳房外形满意率87.5％.结论:局部进展期乳腺癌新辅助化疗后保乳治疗是可行的,严格把握适应证及精确的术前评估是成功的关键.     

新辅助化疗联合乳腔镜保乳手术64例临床分析

目的探讨新辅助化疗联合乳腔镜保乳手术近期疗效及美容效果.方法64例乳腺癌接受CEFi方案化疗2～4周期后行乳腔镜保乳术.结果CEFi方案新辅助化疗CR 5例,PR 52例,SD 5例客观有效率92.0%(57/62),病理学完全缓解率6.5%(4/62),保乳手术后对乳腺形态满意率98.4%(63/64).随访2～30个月,平均18个月,未发现局部复发.结论早期乳腺癌新辅助化疗,肿物降低分期,便于保乳治疗.乳腔镜保乳并发症少,乳腺形态变化小,美观效果好.     

乳腺癌保留乳腺手术后肿瘤复发及转移的相关因素

目的　探讨乳腺癌保留乳腺手术后局部复发及远处转移的相关因素。　方法　回顾性分析保乳治疗原发性女性乳腺癌 174例 ,随访 12～ 196个月 ,随访率 97 13% ( 16 9/ 174)。　结果局部复发9例 ,3年复发率 3 79% ( 5 / 132 ) ;远处转移 14例 ,5年转移率 10 99% ( 10 / 91) ;5年生存率92 31% ( 84/ 91)。保乳手术无放疗组 3年复发率 ( 12 12 % )显著高于手术加放疗组 ( 1 0 1% ) ,( χ2 =5 6 1,P <0 0 5 )。腋窝淋巴结阳性患者中保乳手术未化疗组 5年远处转移率 ( 44 4 4% )高于手术加化疗组 ( 6 6 7% ,P <0 0 5 )。切缘阳性与局部复发有关 (P <0 0 1)。乳腺癌诊断时年龄≤ 40岁、淋巴结阳性、组织学Ⅲ级与远处转移有关 (P <0 0 5 )。　结论　保乳术后应放疗 ;切缘阳性者应再切除至阴性或全乳切除术 ;年轻、淋巴结阳性、组织学分级Ⅲ级者应辅助化疗。     

晚期乳腺癌新辅助化疗的临床报告

目的　探讨新辅助化疗在晚期乳腺癌治疗中的远期临床效果。方法　对 31例Ⅲ、Ⅳ期的乳腺癌患者行新辅助化疗 ,手术前行 2周期的CAF方案化疗〔CTX 5 0 0mg/m2 静脉推注 (第 1、8天 ) ,5 FU 5 0 0mg/m2 静脉推注 (第 1、8天 ) ,ADM 30mg/m2 静脉推注 (第 1天 ) ,每 2 1天为 1周期〕 ,并与同期未行任何术前治疗的可手术的30例Ⅲa期患者作对比分析。结果　新辅助化疗组的总有效率为 87.1% (2 7/31) ,有 6 1.3% (19/31)的患者分期降低 ,其中 6例降为Ⅲa期 ,8例降为Ⅱb期 ,4例降为Ⅱa期 ,1例降为 0期 ,临床完全缓解 1例 ,无病理完全缓解。新辅助化疗组的无病生存期为 5 6 .3个月 ,明显高于未行化疗组的 4 3.5个月 (P<0 .0 5 ) ,新辅助化疗组的 5年无病生存率为 38.7% ,略高于未化疗组的 33.3% ,两组间差异无显著性意义。结论　新辅助化疗能降低晚期乳腺癌患者的分期 ,为手术创造最佳机会 ,能明显延长晚期乳腺癌患者的无病生存期 ,减少或延缓肿瘤的复发、转移。     

新辅助化疗联合保乳手术在中晚期乳腺癌中临床疗效的分析

目的：探讨新辅助化疗联合保乳手术在中晚期乳腺癌治疗中的临床疗效及应用价值。 方法：回顾性分析2008年2月—2010年2月收治的II~III期乳腺癌97例的临床资料,其中新辅助化疗联合保乳手术41例（保乳组,术前行新辅助化疗）和改良根治术56例（改良根治组,术前未行化疗）,对两组临床疗效进行评估。 结果：保乳组客观缓解率高于改良根治组（73.17% vs. 57.14%,P<0.05）。经23.2个月中位随访,保乳组全部存活,局部复发1例,未发生远处转移;改良根治组局部复发6例,5例发生远处转移,其中3例死亡;保乳组与改良根治组中位无进展生存期分别为32.3个月和22.1个月（P<0.05）。保乳组乳房外形评价82.93%为优;患者美观满意度90.24%为非常满意,7.32%为基本 满意。 结论：保乳术前辅助化疗可明显使中晚期乳腺癌临床分期降低,且术后近期疗效和美观效果均好,这对部分中晚期患者来说具有重要临床价值。     

Surgical Procedures After Neoadjuvant Chemotherapy in Operable Breast Cancer: Results of the GEPARDUO Trial

Background Neoadjuvant chemotherapy can increase the rate of breast-conserving surgery in patients with operable breast cancer. However, uncertainty remains regarding surgical procedures and predictors for successful breast-conserving surgery.Methods This study was an analysis of surgical data of a representative data subset of 607 patients enrolled in the GEPARDUO study. This prospective, multicenter, phase III study randomly assigned patients with operable breast cancer (≥ 2 cm) to neoadjuvant 8-week dose-dense doxorubicin plus docetaxel or a 24-week schedule of doxorubicin plus cyclophosphamide followed by docetaxel (AC-DOC).Results Breast conservation was attempted in 493 (81.2%) patients, but 43 patients eventually required mastectomy, thus resulting in a breast-conserving surgery rate of 74.1%. Breast-conserving re-excision was performed in 61 patients (12.4%). Factors associated with a significantly higher breast-conserving surgery rate were a prechemotherapy tumor size ≤ 40 mm, nonlobular histological characteristics, treatment with AC-DOC, clinical response, postchemotherapy tumor size ≤ 20 mm, and treatment in a larger center (>10 enrolled patients). Nonlobular histological characteristics and intraoperative frozen-section analysis for margin evaluation were associated with significantly lower reoperation rates (P = .015).Conclusions Breast conservation after neoadjuvant chemotherapy is feasible in most patients with operable breast cancer. For surgical planning, tumor characteristics and response to neoadjuvant chemotherapy should be taken into account. Improved breast-imaging modalities are necessary to improve detection of residual disease after neoadjuvant chemotherapy, especially when breast cancer is of lobular invasive histology. Margin assessment by intraoperative frozen-section analysis is helpful to avoid reoperation. To achieve an optimal result, an interdisciplinary surgical approach is important.     

乳腺癌新辅助化疗的研究进展

目的探讨乳腺癌新辅助化疗的研究进展。方法从乳腺癌新辅助化疗的理论基础、临床意义、适用范围、常用药物及方案、疗效预测因子及其与保乳手术、前哨淋巴结活检的关系等方面总结乳腺癌新辅助化疗的研究进展。结果新辅助化疗可降低临床分期,增加保乳手术机会,了解化疗药物敏感性,防止远处转移,但对前哨淋巴结活检的影响存在争议。结论新辅助化疗是乳腺癌全身治疗重要的部分,但在如何选择高效的化疗药物、制订个体化方案、预测治疗效果等方面仍需进一步研究。     

三阴性乳腺癌的新辅助化疗：附31 例报告

目的：探讨三阴性乳腺癌（TNBC）新辅助化疗的疗效。 方法：回顾性分析2009年1月―2013年1月收治的63例I~III期TNBC患者临床资料,其中31例术前行新辅助化疗（新辅助化疗组）,32例行直接手术后辅助化疗（术后辅助化疗组）,新辅助化疗与术后的辅助化疗均采用蒽环类为主序贯紫杉类方案。分析新辅助化疗组患者术前获益情况,并比较两组患者术后复发转移与生存率情况。 结果：新辅助化疗组31例患者术前总获益率为100%,其中完全缓解达61.29%（19/31）;3年内发生局部复发和远处转移者新辅助化疗组13例（41.94%）,术后辅助化疗组22例（68.75%）,两组差异有统计学意义（χ2=4.585,P<0.05）。新辅助化疗组和术后辅助化疗组的3年无病生存率分别为48.38%、25.00%;5年总生存率分别为38.71%、9.78%,新辅助化疗组两者均明显优于术后辅助化疗组（χ2=4.870,P=0.027;χ2=7.469,P=0.006）。 结论：蒽环类为主序贯紫杉类方案的新辅助化疗能使TNBC患者明显获益,且远期疗效优于术后辅助化疗。

     

Option of the surgical mode for breast cancer based on the effect of neoadjuvant chemotherapy

Neoadjuvant chemotherapy has become standard treatment for breast cancer patients to avoid mastectomy in larger tumors. Neoadjuvant chemotherapy permits more breast-conserving surgery to be performed. The treatment outcome is favorable in women whose tumors show a complete pathological response. Histological grade, HER-2, p53, and hormone receptor status are significant predictive factors of a good pathological response to neoadjuvant chemotherapy. In addition, computed tomography and/or magnetic resonance imaging are useful tools in determining the optimal resection area for breast cancer.     

Neoadjuvant Chemotherapy in Invasive Lobular Carcinoma May Not Improve Rates of Breast Conservation

Background  Patients with invasive lobular carcinoma (ILC) experience a lower pathological complete response rate to neoadjuvant chemotherapy than patients with invasive ductal carcinoma. This study was intended to evaluate the impact of neoadjuvant chemotherapy in ILC on breast-conserving surgery (BCS) rates. Methods  Two-hundred eighty-four consecutive patients with pure ILC treated between May 1998 and September 2006 were reviewed. Surgical procedures and long-term outcomes were compared between patients receiving neoadjuvant chemotherapy and those receiving surgery first. Results  Neoadjuvant chemotherapy was administered to 84 patients; 200 patients underwent surgery first. The mean tumor size in the neoadjuvant group (4.9 cm) was significantly larger than in patients who underwent surgery first (2.5 cm, p < 0.0001). In the neoadjuvant group, clinical complete response was seen in 10% and partial response in 59%. Overall BCS rates were 17% in the neoadjuvant group compared with 43% in the surgery-first group (p < 0.0001). When controlled for initial tumor size, there was no difference (all p > 0.05) between the groups in terms of (1) the proportion of patients who underwent an initial attempt at BCS, (2) rate of failure of BCS or (3) the proportion of patients undergoing BCS as their final procedure. With a mean follow-up of 47 months, local recurrence (LR) rates were similar between the two groups (1.2% versus 0.5%, p = 0.5). Conclusion  The use of neoadjuvant chemotherapy does not increase the rates of breast conservation in patients with pure ILC.     

Neoadjuvant chemotherapy in breast cancer

BACKGROUND: Neoadjuvant chemotherapy for breast cancer was originally used in locally advanced inoperable disease in order to achieve surgical resection. It was then extended to operable breast cancer with a view to downstaging tumours to facilitate breast-conserving surgery. Increasingly, it is being considered as a treatment for earlier-stage disease. METHODS: A Medline literature search was performed to identify articles relating to neoadjuvant chemotherapy in breast cancer published in the English language between 1960 and 2004. Secondary references were obtained from key articles. Search words included 'neoadjuvant chemotherapy', 'breast cancer', 'tumour biology', 'tumour markers' and 'sentinel lymph node biopsy'. RESULTS: Long-term results from randomized studies have shown no difference in disease-free or overall survival between neoadjuvant and adjuvant chemotherapy. The main benefit of neoadjuvant chemotherapy is its ability to downstage large tumours with a view to treatment by breast-conserving surgery, although there is a non-significant increase in the local recurrence rate. Initial results of neoadjuvant chemotherapy trials using newer agents such as taxanes have demonstrated a greater pathological complete response. Whether this will translate into better long-term survival remains to be seen.     

乳腺癌根治术与保乳术对患者治疗效果的比较分析

目的 比较接受根治术或保乳术治疗的早期乳腺癌患者间的差异,为患者选择根治术或保乳术治疗乳腺癌提供合理依据.方法 回顾性分析宝鸡市第三人民医院普外科2009年1月-2012年1月收治的477例乳腺癌患者的病例资料,根据手术方法的不同,将其分为观察组(229例,48％)和对照组(248例,52％),其中观察组进行保乳术治疗,对照组进行根治术治疗,采用SPSS15.0统计学软件分析比较这两组患者复发率、术后并发症发生率、生存质量、乳房美容效果以及远期疗效等指标.结果 观察组患者的并发症发生率低于对照组(P＜0.05),但患者的l、3年内复发率与转移率与对照组相比,两组间差异无统计学意义(P＞0.05);观察组患者的生存质量与对照组相比差异具有统计学意义(P＜0.05);观察组美容效果的优良率达78.16％,明显高于对照组61.29％,差异具有统计学意义(x2=5.86,P＜0.05);两组用于衡量远期疗效的两项指标:总生存期(x2=3.154,P＞0.05)和无疾病进展生存期(x2=4.243,P＞0.05)间的差异无统计学意义.结论 在不影响患者术后复发率、转移率以及远期疗效的前提下,接受保乳术治疗的患者与接受根治术治疗的患者相比,具有并发症发生率低、美容效果好、生存质量高等显著优势.与传统根治术相比较,保乳术不失为一项明智的选择.     

Breast conservation after neoadjuvant chemotherapy for stage II carcinoma of the breast

BACKGROUND: Neoadjuvant chemotherapy has become the standard treatment for stage III breast cancer. Gratifying results in these patients prompted this prospective, nonrandomized study of neoadjuvant chemotherapy in stage II breast cancer. This study presents our experience with neoadjuvant chemotherapy in 127 patients with stage II carcinoma of the breast. STUDY DESIGN: Patients with stages IIA (T > 3.0 cm) and IIB carcinoma were considered for this study and underwent treatment with cyclic chemotherapy until a plateau of response was achieved. Responders underwent breast conservation or mastectomy according to conventional assessment. Chemotherapy was continued in the adjuvant setting. Survival data were compared with historic controls. RESULTS: Between 1981 and 2001, 127 women between the ages of 22 and 80 years (mean age 52, median age 50), with stage II breast cancer were enrolled, with median followup of 60 months. One hundred twenty-two patients (96.1%) responded to chemotherapy. Of this group, 35 (29.2%) experienced complete pathologic responses or had only microscopic foci of disease after treatment. Sixty-two patients (52.5%) had negative lymph nodes at the time of the operation; 28 of these patients were previously considered N-1 clinically. Seventy-six patients (62%) underwent breast conservation. Overall survivals at 5 years for stage IIA and IIB disease were 94.7% and 88%, respectively. Disease-free survival at 5 years was 85.2% for stage IIA patients and 69.1% for stage IIB patients. CONCLUSIONS: Neoadjuvant chemotherapy can be effectively applied to patients with stage II disease, and breast conservation becomes feasible in the majority of patients. When compared with historic controls, the current study suggests a statistically significant overall survival advantage (p < 0.007) at 5 years.     

Neoadjuvant chemotherapy in stage III breast cancer

Neoadjuvant chemotherapy in advanced breast cancer can potentially downstage disease prior to definitive surgery. In this study, a doxorubicin-based neoadjuvant regimen was administered to stage III breast cancer patients to assess 1) primary tumor response, 2) tumor involvement of resection margins, and 3) predictive value in cancer outcome. Eighty-two patients with stage IIIA and IIIB breast cancer diagnosed between 1990 and 2003 were studied. All patients received similar chemotherapy regimens, consisting of doxorubicin, cisplatin, and 5-fluorouracil, plus surgery and radiation therapy. End points measured include primary tumor response [complete response (CR) = 100%, partial response (PR) > 50%, or no response (NR) < or = 50%], resection margins for tumor, disease-free, and overall survival. Kaplan-Meier and log-rank tests were performed. Of the 82 patients studied, 34 received neoadjuvant therapy, 48 received conventional postoperative treatment. Seventy-two per cent of the stage IIIB and 22 per cent of the stage IIIA patients received neoadjuvant therapy. In the neoadjuvant group, 29 (85%) patients demonstrated tumor response, 9 (26%) of which were CR. Tumor-free resection margins were achieved in 94 per cent of the neoadjuvant group. Survival analysis demonstrated no benefit comparing neoadjuvant versus postoperative adjuvant therapy but hints at improved disease-free survival in neoadjuvant CR patients (log-rank test, P = 0.07). Eighty-five per cent of patients with stage III breast cancer treated with neoadjuvant chemotherapy experienced clinical response, with 26 per cent CR, and 97 per cent tumor-free resection margins. CR may portend a better cancer outcome.