新辅助化疗及保乳手术在Ⅱ|Ⅲ期乳腺癌中的治疗作用

目的探讨新辅助化疗及保乳手术在Ⅱ,Ⅲ期乳腺癌治疗中的作用。方法对观察组46例Ⅱ,Ⅲ期乳腺癌经新辅助化疗后接受保乳手术治疗的患者进行随访观察,并与59例患者对照研究。新辅助化疗方案为表阿霉素60 mg/m2第1天静脉注射,紫杉醇150 mg/m2。第2天持续3 h静脉滴注,21 d为1个疗程。保乳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除。对照组常规行根治性切除术。术后对乳房外形及局部复发、远处转移进行随访观察。结果新辅助化疗后,观察组术前肿瘤病灶临床完全缓解(CR)9例,部分缓解(PR)37例。术后病理学检查发现,观察组癌细胞均有不同程度的变性、坏死,细胞间质水肿,纤维增生,炎性细胞浸润;其中病理完全缓解(PCR)4例。对保乳综合治疗(放疗+化疗)结束后1年的31例患者进行外形评估,其中优19.4%(6/31),良58.1%(18/31),差22.6%(7/31)。观察组局部复发率为8.7%(4/46),对照组为6.8%(4/59),两组比较无统计学意义(P0.05);观察组远处转移率为6.5%(3/46),与对照组(15.3%,9/59)比较无统计学意义(P0.05)。结论新辅助化疗后行保乳手术治疗Ⅱ,Ⅲ期乳腺癌基本是安全的,可达到根治性手术的效果。新辅助化疗,规范化切除,术后放疗、化疗是保乳治疗成功的关键。

The role of neoadjuvant chemotherapy and breast-conserving surgery in stage II| III breast cancer

Objective：To investigate the role of neoadjuvant chemotherapy（NAC）and breast-conserving surgery for stage II,III breast cancer.
Methods：Forty-six patients with stage II,III breast cancer underwent breast-conserving surgery after neoadjuvant chemotherapy were reviewed and followed-up. The control group included 59 patients who underwent radical mastectomy only. Neoadjuvant chemotherapy protocol was as follows: intravenous injection with epirubicin 60 mg/m on day 1 and paclitaxel 150mg/m continuous intravenous infusion for 3 hours on day 2. One course of neoadjuvant chemotherapy was 21 days. Patients eligible for breast-conserving therapy in study group were given quadrantectomy or wide local excision of tumor with axillary lymph node dissection.  The breast cosmetic status, local recurrence and metastasis rate were followed up after surgery.
Results：In study group, after neoadjuvant chemotherapy, 9 cases achieved clinical complete response (CR) and 37 cases achieved partial response (PR). The post-operative pathological examination showed varying degrees of apomorphosis and necrosis of tumor cell, intercellular substance edema, fibrous hyperplasia and inflammatory cell invasion. Four cases had pathological complete response. Assessment of cosmetic results, 1 year after combined therapy(chemotherapy plus radiotherapy), was carried out in 31 cases who had received breast-conserving therapy, and excellent results were obtained in 19.4% (6/31), good in 58.1% (18/31), and poor in 22.6% (7/31) of the patients. The local recurrence rate was 8.7% (4/46) in study group, and 6.8%(4/59) in control group,there was no significant difference between the two groups(P＞0.05). The metastasis rate in study group was 6.5%（3/46） and in control group was 15.3%（9/59）(P＞0.05).
Conclusions：Neoadjuvant chemotherapy followed by breast-conserving surgery for stage II and III breast cancer is safe and can achieve the results of radical operation. Neoadjuvant chemotherapy, strict adherence to standerdize surgical technique and use of postoperative radiotherapy and chemotherapy are crucial to breast-conserving therapy for these patients.