A randomized prospective trial of radical (Halsted) mastectomy versus modified radical mastectomy in 311 breast cancer patients.

This study reports the results of a prospectively randomized trial for treatment of carcinoma of the breast comparing standard (Halsted) radical mastectomy to a modified radical mastectomy. Three hundred eleven patients with primary operable carcinoma of the breast were entered in a surgical and adjunctive chemotherapy trial in Alabama between 1975 and 1978. A total of 91 surgeons participated (all Diplomats of the American Board of Surgery and Members of the American College of Surgeons). All operative reports, pathology and therapy were reviewed by referees. Histologically node positive patients were randomized after operation to receive melphalan or C.M.F.(cytoxan, methotrexate, and 5-FU) for 1 year. After a median follow-up of 5.5 years, there was no significant difference in disease-free survival or in overall survival between the two groups. There was a trend toward improved 5-year survival rates in the radical mastectomy group compared to the modified radical mastectomy group (84% vs. 76%, p = 0.14). There was also an increased incidence of local wound recurrence in those patients receiving modified radical mastectomy, but the differences were not statistically significant (p = 0.09). Longer follow-up will be necessary to evaluate these results more fully.     

A role of interpectoral (Rotter's) lymph node dissection in modified radical mastectomy for breast cancer]

To study the influence of interpectoral lymph node (IPN) dissection on the prognosis of patients who underwent modified radical mastectomy, IPN was carefully dissected and studied pathologically on 168 cases of our breast cancer patients operated with modified radical mastectomy. There were 1.2 lymph nodes on an average in the interpectoral region, and they were almost 1-2mm in diameter. IPN metastases were found in 10 cases. (Tis: 0%, Stage I: 4.9%, Stage II: 5.7%, Stage III: 13%). Tumors located in outer quadrant in almost all these cases. Positive IPN were found in 6 (16%) of n1 alpha group, 1 (10%) of n1 beta group, and in 3 (50%) of n2 group. All these 3 cases of n2 died of distant metastasis and local recurrence. Two (1.7%) of axillary node (1a, 1b) negative patients had microinvolvement of cancer only in IPN, and are currently disease-free. These data suggest that IPN metastasis may occur even in the early breast cancer patients, and that may be controllable by lymph node excision. Therefore, routine and careful dissection of IPN through wide opening of sulcus interpectoralis is necessary for modified radical mastectomy and even for breast preserving operation.     

208例T1-2N1M0期乳腺癌改良根治术患者无病生存情况的危险因素分析

目的探究行改良根治术的T1-2N1M0期乳腺癌患者无病生存的影响因素。 方法回顾性分析2011年1月至2014年11月经改良根治术治疗208例T1-2N1M0期乳腺癌患者资料,统计术后截止2019年11月患者随访情况,并记录患者术后5年肿瘤转移、复发情况,以SPSS 22.00统计学软件进行数据处理。计数资料用[例(%)]表示,组间比较采用χ²检验;乳腺癌患者预后的相关因素行单因素和Cox多因素回归模型分析,P<0.05差异有统计学意义。 结果本次研究中208例患者均获得确切随访,无失访病例。其中复发、转移28例(13.5%),无转移复发180例(86.5%),患者5年无病生存率为86.5%;将单因素分析结果具有统计学意义的变量纳入Cox多因素回归模型。结果显示,年龄<45岁、组织学分级为III级、术后放疗、Ki-6 ≥30%为行改良根治术T1-2N1M0期乳腺癌患者复发转移的独立预后因素(P<0.05)。 结论年龄<45岁、组织学分级为III级、术后放疗、Ki-67≥30%是T1-2N1M0期乳腺癌患者行改良根治术后复发转移的独立危险因素,增加患者预后风险。     

Ⅰ期和Ⅱ期乳腺癌保乳手术与改良根治术临床疗效对比研究

目的：探讨保乳手术与改良根治术治疗Ⅰ、Ⅱ期乳腺癌的临床疗效差异。方法：系统回顾2000年1月—2009年1月我院肿瘤外科收治的45例接受保乳手术的乳腺癌患者的临床资料,将其与同时期接受改良根治术的120例乳腺癌患者进行对比,比较2组患者在术后早期并发症、生存率、术后局部复发及远处转移、术后美容效果和生活质量方面的差异。结果：乳腺癌患者术后早期并发症主要为皮下积液、皮瓣坏死和患侧上肢水肿,此方面2组患者差异无统计学意义;术后复发、远处转移率和生存期2组患者的差异亦无统计学意义;而保乳手术术后美容效果和生活质量显著优于改良根治术,二者差异有统计学意义（P〈0.05）。结论：保乳手术和改良根治术在Ⅰ、Ⅱ期乳腺癌患者的术后早期并发症、生存率、术后复发和远处转移方面无明显差异,而在术后美容效果和生活质量方面,保乳手术明显优于改良根治术。保乳手术是Ⅰ、Ⅱ期乳腺癌的最佳手术方式。     

保留乳头乳晕的乳腺癌改良根治术与传统乳腺癌改良根治术的临床疗效对比

目的探讨保留乳头乳晕的乳腺癌改良根治术与传统乳腺癌改良根治术的临床效果。方法选取2011年6月至2014年3月拟实施手术治疗的乳腺癌患者60例,采用随机数字表法分为改良组(保留乳头乳晕的乳腺癌改良根治术)、传统组(传统乳腺癌改良根治术)各30例,对比两组患者的治疗效果。数据分析采用SAS10.0进行处理,手术相关指标、FACT-B评分采用均数±标准差(x珋±s)进行描述,t检验;乳房外观美观程度、并发症率、局部复发率、远处转移率、生存率采用χ2检验;P值0.05表示差异有统计学意义。结果改良组的手术时间、手术出血量均高于传统组(P0.05),两组淋巴结清扫数目比较差异无统计学意义(P0.05);改良组的术后乳房外观优9例(30.0%)、良16例(53.3%),传统组术后乳房外观优1例(3.3%)、良14例(46.7%),改良组术后乳房美观效果优于传统组(P0.05);改良组的术后并发症率16.7%,传统组33.3%,两组比较差异无统计学意义(P0.05);术后1年,改良组的社会/家庭状况、功能状况、情感状况及FACT-B总分均高于改良组(P0.05);随访36个月的局部复发率、远处转移、生存率与两组比较差异均无统计学意义(P0.05)。结论保留乳头乳晕的乳腺癌改良根治术术后患者乳房外观恢复较好、生存质量较高,同时3年预后与传统乳腺癌改良根治术基本相当。     

The primary management of breast cancer: is breast conservation feasible for all patients?

A consecutive series of 411 patients with primary breast cancer treated by a consistent policy of breast conservation, regardless of tumour size, location, clinical stage or histological subtype, is reported. Actuarial 5-year survival was 84% for UICC Stage I, 73% for Stage II and 47% for Stage III/IV. The incidence of local recurrence at 5 years was 13% for Stage I, 12% for Stage II, and 26% for Stage III/IV. The probability of salvage mastectomy at 5 years was 5% for Stage I, 8% for Stage II, and 15% for Stage III/IV. Of local recurrences, 40% were managed with further breast conservation. Primary treatment with breast conservation results in satisfactory local control rates, 5-year survival and cosmesis, but the prevention, diagnosis and treatment of local recurrence within the conserved breast requires further evaluation.     

II,III期乳腺癌行根治术与扩大根治术的疗效评价:附691例报告

目的　探讨乳腺癌根治术与扩大根治术治疗II ,III期乳腺癌的疗效。方法　回顾性分析691例II ,III期乳腺癌的两种手术方法治疗后的 5年和 10年生存率。 691例乳腺癌中II期行根治术 2 0 6例 ,行扩大根治术 14 2例 ;III期行根治术 193例 ,行扩大根治术 15 0例。结果　癌灶位于中央区及内乳区行扩大根治术的II ,III期患者的 5年生存率和III期的 10年生存率显著高于根治术患者 (均P <0 .0 1)。癌灶位于外上象限行扩大根治术的II ,III期患者 10年生存率和III期患者的 5年生存率亦显著高于根治术患者 (均 P <0 .0 5 )。结论　提示II ,III期乳腺癌病灶位于中央区及内乳区的患者、位于外上象限的III期患者应考虑行扩大根治术。     

Axillary recurrence after modified radical mastectomy

Optimal management for axillary recurrence is poorly understood. The aim of this study was to evaluate the risk factors for overall survival in the patients with axillary recurrence. Data of 1098 patients were collected from breast cancer registers from Clinic for Oncology Nis between 1990-1995. All patients underwent modified radical mastectomy. Axillary recurence was diganosed in 43 (3.92%) patients. Most patients were presented with a localized, palpable axillary mass 30 (69.77%). Cox multivariate analysis of prognostic factors for breast cancer-specific survival showed that node status HR 4.69 (1.50 to 14.72), tumor size HR 3.18 (0.90 to 11.26) and axillary radiotherapy HR 1.99 (0.69 to 5.75) had statistically significant effect on breast cancer mortality. Log-rank (54.21 p < 0.001) analysis showed significant difference for overall survival among women with a axillary recurrence based on different cancer stages. Tumor size and node status were the most important prognostic factors in women with axillary recurrence.     

保留胸大、小肌改良乳腺癌根治术214例

目的探讨保留胸大、小肌改良乳腺癌根治术的临床疗效。方法回顾性分析214例乳腺癌(Ⅰ期66例,Ⅱ期141例,Ⅲ期7例)施行保留胸大、小肌改良乳腺癌根治术的治疗结果。结果214例患者中术后发生皮下积液12例(5．6％),皮缘坏死16例(7．4％),上肢淋巴性水肿8例(3．7％),胸肌挛缩伴同侧上臂运动障碍11例(5．1％)。3年生存率为82．3％,5年生存率为63．4％,其中Ⅰ期5年生存率为79．6％,Ⅱ期5年生存率为56．3％。结论重视保护胸外侧支神经可避免胸肌挛缩导致的上臂运动障碍,重视术后早期化疗能有效地预防复发和转移,重视创面综合处理可减少皮下积液,重视加强术后综合治疗可提高远期疗效。     

Five-year results of a randomized clinical trial comparing modified radical mastectomy and extended radical mastectomy for stage II breast cancer

A controlled cooperative study was carried out to assess the value of modified radical mastectomy for patients with stage II breast cancer. The data was analyzed from 11 institutions in the Shikoku District participating in a prospective clinical trial in which patients were randomly assigned either to a modified radical mastectomy group or an extended radical mastectomy group. These two groups of patients were similar to each other in terms of such background factors as age distribution, menopausal status, TNM classification, tumor size, location of the primary tumor, axillary nodal involvement, histological type, and estrogen receptor status. The median follow-up times in the modified and extended radical mastectomy groups were 4.7 and 4.5 years, respectively. The cumulative curves indicated no difference between the two groups in either disease-free survival or overall survival. The survival rates were classified according to the presence or absence of axillary nodal metastases. However, no significant difference was found between the two groups. These findings thus suggest that the routine removal of the grossly uninvolved major pectoral muscle and parasternal lymph nodes is not necessary in patients with stage II breast cancer.     

保乳手术和改良根治术治疗早期乳腺癌的临床疗效分析

目的探讨和比较保乳手术和改良根治术治疗早期乳腺癌的临床疗效和安全性。方法回顾性分析2013年1月至2015年9月期间接受外科手术治疗的100例早期乳腺癌手术患者的临床资料,根据患者的手术方式进行分组,其中保乳手术组(保乳组)50例,改良根治术组(改良组)50例,采用SPSS 19.0统计分析,两组患者的手术时间、术中出血量、住院天数等用"均数±标准差"表示,组间比较采用t检验;术后并发症发生情况、乳房美容效果、术后肿瘤局部复发率、远处转移率、1年生存率等用"%"形式表示,组间比较采用χ2检验。P0.05差异有统计学意义。结果保乳组手术时间、术中出血量、住院时间及术后并发症发生率均少于改良组(P0.05),美容效果优良率高于改良组(P0.05)。两组患者术后肿瘤局部复发率、远处转移率、1年生存率差异均无统计学意义(P0.05)。结论保乳手术与改良根治术治疗早期乳腺癌疗效确切,但保乳手术对患者损伤小、出血量少、并发症少、美容效果好,值得推广应用。     

保留乳房的改良式乳腺癌根治术21例报告

目的 探讨保留乳房的乳腺癌根治术的适应证、手术和术后治疗。方法 回顾性分析21例早期乳腺癌患者行保留乳房改良式乳腺癌根治术的临床资料。结果 所有病例术后经过良好，乳房外形正常，随访3-20个月，无复发及并发症。结论 对早期乳腺癌，可行保留乳房的根治术，术后乳房外形正常，患者生存质量高。但术后应定期随访，以便及时发现和治疗乳腺癌复发。     

Aggressive therapy for locoregional recurrence after mastectomy in stage II and III breast cancer patients

Background: To determine if aggressive treatment of locoregional recurrence affects survival, we retrospectively analyzed the clinical outcome of 69 breast cancer patients who developed locoregional disease as their first episode of recurrence following mastectomy and adjuvant chemotherapy. Methods: Patients were identified from among 1,707 stage II and III breast cancer patients who enrolled in five different doxorubicin-based adjuvant chemotherapy protocols at The University of Texas M. D. Anderson Cancer Center from 1975 to 1986. Sixty-nine evaluable patients who had a locoregional recurrence as the first site of relapse after mastectomy formed the study group. Multifactorial analysis of clinical and histopathological characteristics of both the primary tumor and the subsequent recurrence was performed using a logistic regression method. Survival analysis was performed using an actuarial life-table method calculated from the date of registration into the adjuvant therapy protocols. Results: Median follow-up was 6.6 years. Two factors significantly affected survival: recurrence of disease during or after adjuvant treatment of the primary and whether the patient was rendered disease free after recurrence. Conclusions: Stage II and III breast cancer patients who have locoregional recurrence after adjuvant chemotherapy and can be rendered disease free may have a better survival rate. Aggressive treatment of locoregional recurrence including complete surgical excision should be considered in this subgroup of patients.     

Modified radical mastectomy in the treatment of stage III breast carcinoma

From 1972 to 1982, 237 patients with stage III breast carcinoma were admitted into our institute. One hundred and eleven cases underwent Auchincloss and Madden modified radical mastectomy (MRM), and the remaining 126 cases received Halsted radical mastectomy (RM). The 5 and 10 years survival rates were 59.17% (61/111), and 36.92% (24/65) in MRM group. The 5 and 10 years survival rates were 53.17% (67/126) and 29.31% (17/58) in RM group. There were no statistically significant differences in the long-term survival rates between the two groups (P greater than 0.05). The authors believe that MRM causing less trauma should be considered in the treatment of stage III breast carcinoma unless in cases with major pectorial muscle involvement or large metastatic axillary nodes.     

保留乳房的乳腺癌改良根治术治疗早期乳腺癌的临床观察

目的探讨保留乳房的乳腺癌根治术治疗早期乳腺癌的疗效。方法对22例早期乳腺癌患者行保乳手术治疗，术后并行辅助放疗、化疗等综合治疗。结果全组随访6～48个月，无局部复发和远处转移，3年生存率100％（17／17）。结论对早期乳腺癌行保乳手术疗效满意，严格掌握手术指征，规范的切除和术后放疗、化疗等综合治疗是保乳手术治疗成功的关键。     

Modified radical mastectomy.

The recent history of operations for breast cancer indicates a growing trend toward conservatism. The modified radical mastectomy achieves the goal of removing all evidence of cancer in the breast involved and removes the regional lymph nodes for accurate staging of the disease. In addition, it provides a cosmetic result superior to that of the standard radical mastectomy. Breast reconstruction may be undertaken at a later time with excellent result. The 5 and 10 year survival rates of comparable groups of patients after modified radical mastectomy and standard radical mastectomy appear to be almost identical.     

保留乳房的乳腺癌切除术与改良根治术治疗绝经前乳腺癌患者的效果比较

目的探讨保留乳房的乳腺癌切除术与改良根治术治疗绝经前乳腺癌患者的效果比较。 方法选取2009年10月至2012年10月住院治疗的绝经前乳腺癌患者160例进行前瞻性研究,根据手术术式的不同应用随机数字法分为保乳组(80例)和根治组(80例),其中保乳组采用保留乳房的乳腺癌切除术,根治组采用改良根治术进行治疗。应用SPSS 20.0统计学软件进行统计学处理,术中相关指标及乳腺癌治疗功能评价系统以( ±s)表示,采用独立t检验;生存率、局部复发率及远处转移率采用卡方检验,以P<0.05表示差异具有统计学意义。 结果与根治组相比,保乳组患者的术中出血量显著降低(P<0.05),手术时间和住院时间显著缩短(P<0.05);两组患者的2年生存率均为100%,保乳组患者的5年生存率、5年局部复发率和5年远处转移率分别为80例(100.0%)、3例(3.8%)和1例(1.3%),根治组分别为78例(96.3%)、5例(6.3%)和3例(3.8%),两组相比,差异均无统计学意义(χ²＝3.057, 0.526, 1.026, P>0.05);与根治组相比,保乳组患者的FACT－B和生理状况均显著提高(P<0.05);而两组患者的社会/家庭状况、功能状况、功能状况、情感状况和乳腺癌附加关注相比差异均无统计学意义(P>0.05)。 结论保留乳房的乳腺癌切除术治疗绝经前乳腺癌患者的临床效果较好,且可显著提高患者的生活质量。     

胸大肌包裹假体置入一期乳房重建在保留皮肤的乳癌根治术中的应用

目的：探讨保留皮肤的乳腺癌改良根治术一期胸大肌包裹假体置入乳房重建的可行性。方法：对28例0、I、II期乳腺癌患者行保留皮肤的乳腺癌改良根治术后,同期于胸大肌后方置入硅胶假体重建乳房,并根据冰冻切片检查结果决定是否保留乳头乳晕复合体。结果：28例早期乳腺癌患者均保留了乳头乳晕复合体,术后随访2～18个月,外观良好,双侧乳房对称,优良率达96.5%。所有病例均无局部复发或远处转移,无明显术后并发症。结论：保留皮肤的乳腺癌改良根治术后用硅胶假体行一期乳房重建,能达到满意的乳房美容效果,是治疗早期乳腺癌安全可行的方法。     

Interim results of treatment of breast cancer with breast conservation for all patients

Since April 1979, all female patients who have come to this unit with carcinoma of the breast have received primary treatment with breast conservation. Until December 1984, 288 patients underwent local excision of the tumor with radical radiotherapy. After 1 to 5 years, the overall and recurrence-free survival rates have been comparable with those expected after mastectomy. Local recurrence occurred in 7 of 76 (9%) patients who had stage I disease, and in 16 of 181 (9%) and 3 of 27 (11%) patients with stage II and stage III disease, respectively. Eleven patients required a mastectomy to control recurrence of the cancer, and of the 29 patients who died of breast cancer, only three had symptomatic local disease at the time of death.     

Lymphoma of the breast.

Thirteen patients with lymphoma of the breast are presented. In addition, 163 previously reported cases of lymphoma of the breast are reviewed. Complete staging was performed on all patients. No patient had a diagnosis of lymphoma prior to breast biopsy. The histologic findings were diffuse histiocytic lymphoma (DHL) in eight patients, nodular lymphocytic poorly differentiated lymphoma (NLPD) in two patients, nodular mixed lymphoma (NM) in two patients and nodular sclerosing Hodgkin's disease (NSHD) in one patient. Five patients had Stage IV disease, two had Stage III disease, four had stage II disease and two Stage I disease. Nine patients each underwent an excisional biopsy and four patients each had a modified radical mastectomy as initial therapy. Two patients each underwent a staging laparotomy. In advanced disease, chemotherapy achieved complete remissions in approximately 50% of patients. Unfavorable histologic findings are most common in lymphoma of the breast and thorough staging is necessary to select the best form of therapy. The absolute survival rate (61%) and the disease free survival rate (46%) are similar to nodal lymphoma of corresponding histologic factors and stage.