乳腺癌手术加综合治疗：附86例报告

目的 探讨手术+综合治疗治疗乳腺癌的临床疗效.方法 回顾分析乳腺癌86例行手术+新辅助化疗、术后综合治疗的临床资料.结果 行保乳术38例及改良根治术48例的患者均施行新辅助化疗,术后化疗、放疗,内分泌治疗等.术后随访83例,其3,5,8年生存率:保乳术组分别为97.3%,94.4%,38.2%;改良根治术组为95.7%,93.1%,36.6%,差异无统计学意义.复发率:保乳术组3,5,8年分别为0,5.6%,23.5%.改良根治术组为2.8%,6.8%,26.8%,差异无统计学意义.结论 保乳术或改良根治术+新辅助化疗、术后化疗、放疗、内分泌治疗是提高乳腺癌生存率、减少复发率、改善生活质量的重要措施.     

男性乳腺癌16例临床资料分析

目的:探讨分析男性乳腺癌的临床与病理特点、诊断及治疗方法。方法:回顾性分析2005年1月—2014年6月收治的16例男性乳腺癌的临床资料。结果:主要临床表现为乳腺无痛性肿块,术前均诊断为乳腺癌。均行手术治疗,其中行乳腺癌根治术2例,改良根治术12例,乳房单纯切除术2例。术后病理诊断浸润性导管癌87.5%,I期2例,II期4例,III期8例,IV期2例;5年生存率50.0%。结论:男性乳腺癌发病率低、年龄大、病程长、预后差、容易发生转移。该病以改良根治术为主要治疗方法,辅以化疗、放疗及内分泌治疗。     

男性乳腺癌临床分析：附14例报告

目的探讨男性乳腺癌的临床特点及治疗方法。方法回顾性分析14年余本院收治的14例男性乳腺癌患者的临床资料。结果 14例中髓样癌占7.1%(1/14),浸润性导管癌占92.9%(13/14)。长径1.5～5.2cm。1例(82岁)行单纯乳房切除,3例行乳癌根治术,10例行改良根治术;14例均行患侧腋窝淋巴结清除术,淋巴结转移率71.4%。12例随访9个月至14年,3例死亡,3例带瘤生存,6例无瘤生存;2例失访。随访期间5年生存率58.3%,10年生存率16.7%。采用乳腺癌根治术3例以及采用乳腺癌改良根治术10例均治愈。结论本组中以浸润性导管癌为主,易发生淋巴转移,预后差,10年生存率低。     

妊娠期乳腺癌的诊断和治疗

目的探讨妊娠期乳腺癌的诊断、治疗及预后。方法回顾性分析1986年1月至2007年12月期间笔者所在医院收治的12例妊娠期乳腺癌患者的临床资料和随访资料。结果 12例妊娠期乳腺癌患者中,有8例患者于术前行B超检查,3例患者行钼靶检查,均有阳性发现。12例患者均行手术治疗,其中10例行乳腺癌改良根治术,2例行乳腺癌根治术;7例在妊娠期间确诊的患者中,仅1例行人流术,另外6例行剖宫产;所有患者乳腺癌术后并妊娠结束后均行化疗,5例化疗后再行放疗,1例在妊娠结束后行内分泌治疗。随访期间(平均随访时间35.8个月),1例患者出现胸壁结节,2例盆腔多发转移并死亡,余9例均未出现复发和转移。结论妊娠期乳腺癌可行乳腺切除加腋窝淋巴结清扫术;妊娠结束后可行化疗,妊娠期间不应行放疗及内分泌治疗。     

男性乳腺癌13例临床分析

目的探讨男性乳腺癌的临床与病理特点、诊断及治疗方法。 方法对2000年1月至2011年12月收治的13例男性乳腺癌患者的临床资料进行回顾性分析,全部患者均行手术治疗,其中乳腺单纯切除术2例,乳腺癌改良根治术10例,根治术1例。 结果13例术前均明确了诊断,Ⅰ期2例,Ⅱ期3例,Ⅲ期6例,Ⅳ期2例。术后生存10年以上1例,占7.69%,为Ⅱ期;生存5年以上6例,占46.15%,其中Ⅰ期1例,Ⅱ期3例,Ⅲ期2例。 结论男性乳腺癌发病率低,患者年龄大,病程长,预后差,容易发生转移,本病以手术治疗为主,辅以化疗、放疗及内分泌治疗。     

男性乳腺癌临床分析

目的分析男性乳腺癌的临床特点,为诊断及治疗提供依据。方法回顾性研究2000年至2009年Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期共16例男性乳腺癌患者临床资料及治疗过程。结果本组病例平均年龄为54岁,其中Ⅰ期1例,Ⅱ期10例,Ⅲ期2例,Ⅳ期3例,所有患者均行手术治疗,术后有11例患者行综合治疗（包括化疗、放疗和免疫治疗）。10例患者得到随访,术后随访显示：共4例死亡,其中3例死于复发及转移,1例死于心血管疾病,生存期为3～14年。结论男性乳腺癌发病年龄高,晚期病例多,预后差,应以手术根治或改良根治术为主的综合治疗方案,综合治疗是乳腺癌治疗的方向,也是乳腺癌治疗成功的关键．内分泌治疗是辅助治疗首选。     

青年乳腺癌52例临床分析

对52例青年乳腺癌患者的临床资料进行回顾性分析。按TNM分期，II，III期病例占86.5%。49例行手术治疗，3例行非手术治疗。病理分型以乳腺浸润性癌多见（90.4%）。47例行术后化疗，20例术后放疗。3，5年生存率为44.2%，20.9%。提示青年乳腺癌多数为浸润型癌，发展快，预后差。     

男性乳腺癌诊治分析：附9例报告

目的 总结男性乳腺癌的临床病理特点、诊断、治疗及预后.方法 回顾性分析经手术治疗的9例男性乳腺癌患者的临床资料,均经病理证实诊断,占本院同期收治乳腺癌的0.2%.9例均行手术治疗;其中改良根治术7例,单纯乳腺切除术1例,乳腺肿物扩大切除术1例.术后辅以化疗、放疗和/或内分泌治疗.结果 9例患者平均年龄66.0岁,以浸润性导管癌为主,腋窝淋巴结转移率57.1%,ER,PR,Her-2的阳性率分别为60.0%,100%,33.3%.8例获得随访,平均随访时间74.1个月.5年总生存率60.0%(3/5).2例死亡,其中1例高龄患者死于脑血管意外,另1例死于肝转移,余6例术后已生存10～149个月,无局部复发病例.结论 男性乳腺癌因患病率低,易延误诊治.手术治疗为主的综合治疗是本病目前有效的治疗模式.     

17例炎性乳腺癌的诊断和治疗

目的：探讨炎性乳腺癌的临床特点和治疗方法。方法：对我院1989年2月至1997年11月期间诊治的17例炎性乳腺癌患者的临床资料进行回顾性分析。结果：17例患者中8例行新辅助化疗 乳腺癌改良根治术 术后放疗及化疗患者的平均生存期为33．6个月，1、2、5年仍存活者分别为6例、5例和3例．行其他治疗的9例患者1、2、5年仍存活者分别为5例、3例和0例。结论：新辅助化疗 乳腺癌改良根治术 术后放疗及化疗可提高患者生存率。     

乳腺癌保乳综合治疗的疗效分析

目的　评价I ,IIa期乳腺癌保乳综合治疗的疗效。方法　将 14 1例I ,IIa期乳腺癌 (肿块距乳头≥ 3cm )前瞻性非随机分为两组 :(1)保乳治疗组 68例 ,行保留乳房的肿瘤局部广泛切除加腋窝淋巴结清扫术 ;(2 )对照组 46例 ,行乳癌改良根治术。术后均给予化疗、放疗和 /或内分泌治疗。结果　中位随访 46个月 ,两组病例均无局部复发。保乳治疗组 3a生存率为 98.0 % ,5年生存率为93 .3 % ,远隔脏器转移率为 7.4% ;改良根治组 3年生存率为 97.1% ,5年生存率为 91.3 % ,远隔脏器转移率为 8.7 ,两组各指标比较无明显差异 (P >0 .0 5 )。结论　对癌肿距乳头≥ 3cm的I ,IIa期乳腺癌采用保乳综合疗法 ,可以达到与根治术相似的治疗效果 ,可能逐渐成为治疗I ,IIa期乳腺癌患者的首选术式     

托瑞米芬治疗绝经后可手术luminal型乳腺癌的疗效观察

目的探讨托瑞米芬在中国绝经后可手术luminal型乳腺癌中的作用。方法收集2000年1月至2009年12月期间中山大学肿瘤防治中心收治的绝经后luminal型乳腺癌患者的临床病理资料,使用他莫昔芬（组）或托瑞米芬（组）辅助内分泌治疗共618例（分别为503例和115例）。采用Kaplan-Meier法和log-rank检验分析2组生存情况,Cox比例风险回归模型进行多因素分析。结果托瑞米芬组和他莫昔芬组患者的一般临床病理特征比较差异无统计学意义（P〉0．05）,具有可比性。全组中位随访时间76个月。托瑞米芬组和他莫昔芬组5年无病生存率和5年总生存率比较,差异均无统计学意义（5年无病生存率：78．5％比85．5％,P=-0．083;5年总生存率：86．4％比92.0％,P=0．334）。单因素分析结果显示,组织学分级高、肿块大、淋巴结阳性、分期晚和HER-2阳性是影响绝经后可手术luminal型乳腺癌患者无病生存率和总生存率的不良预后因素泸〈0．05）;多因素分析结果显示,肿块大小和淋巴结状态是影响luminal型乳腺癌患者总生存率和无病生存率的独立预后因素（P〈0．05）。HER-2阳性是影响无病生存率的独立预后因素（P〈0．05）。全组未见CTCAE4．0分级为3／4度的不良反应。结论与他莫昔芬相比,托瑞米芬治疗绝经后可手术luminal型乳腺癌疗效相似,安全性高。HER-2表达状况影响绝经后可手术luminal型乳腺癌患者的无病生存率。     

The safety and effectiveness of liver resection for breast cancer liver metastases: A systematic review

Breast cancer liver metastases have traditionally been considered incurable and any treatment given therefore palliative. Liver resections for breast cancer metastases are being performed, despite there being no robust evidence for which patients benefit. This review aims to determine the safety and effectiveness of liver resection for breast cancer metastases.A systematic literature review was performed and resulted in 33 papers being assembled for analysis. All papers were case series and data extracted was heterogeneous so a meta-analysis was not possible. Safety outcomes were mortality and morbidity (in hospital and 30-day). Effectiveness outcomes were local recurrence, re-hepatectomy, survival (months), 1-, 2-, 3-, 5- year overall survival rate (%), disease free survival (months) and 1-, 2-, 3-, 5- year disease free survival rate (%). Overall median figures were calculated using unweighted median data given in each paper.Results demonstrated that mortality was low across all studies with a median of 0% and a maximum of 5.9%. The median morbidity rate was 15%. Overall survival was a median of 35.1 months and a median 1-, 2-, 3- and 5-year survival of 84.55%, 71.4%, 52.85% and 33% respectively. Median disease free survival was 21.5 months with a 3- and 5-year median disease free survival of 36% and 18%.Whilst the results demonstrate seemingly satisfactory levels of overall survival and disease free survival, the data are of poor quality with multiple confounding variables and small study populations. Recommendations are for extensive pilot and feasibility work with the ultimate aim of conducting a large pragmatic randomised control trial to accurately determine which patients benefit from liver resection for breast cancer liver metastases.     

Clinicopathological Characteristics and Survival Analysis of 87 Male Breast Cancer Cases

BACKGROUND: The aim of this study was to investigate the clinicopathologic characteristics, therapy methods, and prognosis of male breast cancer. PATIENTS AND METHODS: We retrospectively analyzed the clinicopathological characteristics, recurrence or metastasis, and survival information of 87 male breast cancer patients. Statistical analysis included the Kaplan-Meier method to analyze survivals, log-rank to compare curves between groups, and Cox regression for multivariate prognostic analysis. A p value of <0.05 was considered statistically significant. RESULTS: 5-year disease free survival (DFS) and 5-year overall survival (OS) were 66.3 and 77.0%, respectively. Monofactorial analysis showed tumor size, stage, lymph node involvement, and adjuvant chemotherapy to be prognostic factors with regard to 5-year DFS and 5-year OS. Multivariate Cox regression analysis showed tumor size, stage, and adjuvant chemotherapy to be independent prognostic factors with regard to 5-year DFS and 5-year OS. CONCLUSION: Male breast cancer has a lower incidence rate and poor prognosis. Invasive ductal carcinoma is the main pathologic type. Operation-based combined therapy is the standard care for these patients. Tumor size, stage, and adjuvant chemotherapy are independent prognostic factors. More emphasis should be placed on early diagnosis and early therapy, and adjuvant chemotherapy may improve survival.     

乳腺癌保乳治疗十年随访

目的研究乳腺癌保乳治疗的远期疗效及规范化治疗。方法对1990年3月至2010年3月行保乳治疗的93例乳腺癌进行回顾性分析。结果经过125个月的中位随访期,局部复发率3．2％（3／93）,总生存率89．2％（83／93）,美容效果满意率90．3％（84／93）。5年生存率92．3％,元瘤生存率为89．2％;10年生存率89．3％,无瘤生存率为85．7％。在预后相关指标单因素分析中,未能发现年龄、肿瘤大小、临床分期、腋淋巴结转移等因素对预后产生影响。结论早期乳腺癌行保乳治疗,原发肿瘤较大甚至临床分期较晚的乳腺癌经新辅助化疗缩小病灶后行保乳治疗,局部复发率较低,生存率较高,并且明显改善了患者的生活质量。     

Chest wall resection for locally recurrent breast cancer: is it worthwhile?

OBJECTIVE: The effectiveness of chest wall resection for locally recurrent breast cancer as cancer treatment remains poorly defined, possibly because of the general impression that locally recurrent disease is a harbinger of rapidly progressive metastatic disease and that extensive surgical treatment in these patients is inappropriate. Reports to date have focused on technical feasibility, not long-term outcome. METHODS: We reviewed our experience with 38 women who underwent chest wall resection for locally recurrent breast cancer between October 1987 and May 1997. Overall survival was calculated by the Kaplan-Meier method and the significance of prognostic variables evaluated by log-rank and Cox regression analyses. RESULTS: The operative mortality rate was 0%. Overall survival at 1, 3, and 5 years after chest wall resection was 74%, 41%, and 18%, respectively, and the proportion of patients free of local recurrence at 1, 3, and 5 years was 59%, 42%, and 13%, respectively. Regional nodal disease and size of largest tumor nodule (>4 cm) were significant predictors of local re-recurrence (P <.01, P =.04); lymph node metastasis was the only predictor of long-term survival (P <.01). Patients with and without synchronous sites of metastatic disease had near-identical 3-year survivals. CONCLUSIONS: Chest wall resection for locally recurrent breast cancer has a low mortality. However, a significant number of patients have the development of local re-recurrence or metastases, and 5-year survival is limited. It is unlikely that complete resection of all locally recurrent disease improves survival. Future studies should focus on the quality of palliation achieved.     

Ⅲ期乳腺癌术前尺动脉插管灌注化疗的远期疗效

目的　探讨术前尺动脉插管灌注化疗在治疗Ⅲ期乳腺癌中的临床价值。　方法　同期治疗Ⅲ期乳腺癌患者 10 9例 ,其中术前行尺动脉插管灌注化疗 6 4例 ,称A组 ;术前未化疗 45例 ,称B组。观察尺动脉插管灌注化疗对A组患者的疗效 ,并对 2组患者 5、10年生存率及无病生存率进行对比分析。　结果　A组患者的总有效率 76 6 % ,组织学有效率为 89 1% ;5、10年生存率分别为6 4 0 %、47 9% ;5、10年无病存活率分别为 5 9 4%、43 5 % ,均明显高于B组的 5、10年生存率 (31 1%、2 1 9% )及 5、10年无病存活率 (2 2 2 %、12 5 % ) ,差异有显著性意义 (P <0 0 5 )。　结论　术前尺动脉插管灌注化疗是治疗Ⅲ期乳腺癌的一种有效辅助措施 ,能够提高Ⅲ期乳腺癌患者的远期疗效 ,并减少局部复发和远处血行转移。     

Survival following locoregional recurrence after breast conservation therapy for cancer.

We postulated that locoregional recurrence after limited surgery and radiotherapy for breast cancer might be associated with an additional survival hazard, similar to that of a second primary tumor with the same extent of local and regional disease. Using this hypothesis we examined the likely resultant effect on survival. Our calculations indicated that no statistically significant survival deficit due to such recurrence would be detectable until a randomized controlled trial comparing breast conservation with mastectomy had monitored more than 10,000 patients for more than 10 years. A simple mathematical model predicted 5-year survival rates in a cohort of patients treated with breast conservation of 75%, compared to 83% in those without locoregional recurrence. From the date of locoregional recurrence, a 61% 5-year survival rate was predicted, compared to 83% if no hazard was associated with locoregional recurrence. These predictions were compared with the actuarial survival rates of 499 patients with unilateral breast cancer, 49 of whom had developed locoregional recurrence. From the date of initial treatment, the 5-year survival rate of those whose disease recurred was 79%, compared to 88% for those without locoregional recurrence (p = 0.19). The actuarial 5-year survival rate from the date of locoregional recurrence was 63%. The similarity between the patient data and the predictions of the mathematical model indicates that locoregional failure after breast conservation therapy may result in reduced survival. The lack of a significant survival deficit in our cohort or in controlled trials comparing breast conservation therapy with mastectomy is compatible to the small size of the overall effect.     

男性乳腺癌临床特征及诊治：附35例报告

背景与目的 男性乳腺癌是一种非常罕见的疾病，一般确诊时分期较晚，预后差。目前其治疗上多参照女性乳腺癌。笔者通过对男性乳腺癌的病例的回顾分析，探讨该病临床特点及诊治。方法 回顾分析大连医科大学附属第二医院于2003年3月—2019年6月收治的35例男性乳腺癌患者的临床特点、病理特征、治疗及随访情况。结果 全组患者就诊时均无远处转移，中位年龄65岁，主要临床表现为无痛性乳房肿块，所有患者均接受了手术治疗，仅2例（5.7%）患者接受了部分乳腺切除术，其余均接受全乳房切除术或更大范围的手术。18例（51.4%）接受了辅助化疗，4例（11.4%）接受了辅助放疗，17例（48.6%）接受了辅助内分泌治疗。30例（85.7%）术后病理诊断为浸润性导管癌。全组均获得随访，5年总生存率83.4%。结论 加强对男性乳腺癌的认识，做到早期诊断，并进行以手术为主的综合治疗非常重要。男性乳腺癌的诊治仍有待进一步研究和规范。     

晚期乳腺癌新辅助化疗的临床观察

目的探讨新辅助化疗在晚期乳腺癌治疗中的效果。方法对66例Ⅲ,Ⅳ期的乳腺癌患者行新辅助化疗,采用21d为1周期的CAF方案,共2周期〔CTX500mg/m2静脉推注(第1,8天),5-FU500mg/m2静脉推注(第1,8天),ADM30mg/m2静脉推注(第1天)〕,并与同期未行任何术前治疗的可手术的58例Ⅲa期患者作对比分析。结果新辅助化疗组的总有效率为86.36%(57/66),有62.12%(41/66)的患者分期降低。新辅助化疗组的无病生存期为57.6个月,明显高于未行化疗组的42.2个月(P<0.05),新辅助化疗组的5年无病生存率为37.89%,对照组为34.48%。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;减少或延缓肿瘤的复发、转移;并可延长晚期乳腺癌患者的无病生存期。     

Critical Analysis of the Treatment of Non-palpable Breast Cancer:Toward a Less Invasive Future?

Results and experience with the treatmentof non-palpable breast cancer are reported and related to the future ofless invasive treatment of small breast cancers. The retrospectivestudy included 102 patients treated between 1980 and 1993 at theUniversity Hospital of Nijmegen. Most cancers were screen-detected.Tumor sizes on pathological examination proved 3 mm (SD 7.7 mm) largerthan on mammography (p = 0.0029). pT1 tumors wereencountered in 77 patients (75%); pT2 tumors in 17 patients (17%).Seventy-five patients were free of lymph node metastases, 26 patientsshowed stage pN1 (25%). Most patients had invasive ductal cancers.Only two patients died of breast cancer. A 10-year disease-freesurvival of 94% was calculated, after excluding four patients withknown systemic disease (M1) at diagnosis. T1a,T1b, and T1c had a 10-year survival of 100%,96%, and 96%, respectively. Early detection and multimodalitytreatment of breast cancer have significantly improved survival. Inpatients with small breast cancer tumors future developments intreatment must be aimed at the use of less invasive techniques,reducing morbidity while maintaining high levels of disease-freesurvival.