原发性肾肉瘤的诊治及预后(附6例报告及文献复习)

目的：探讨原发性肾肉瘤的诊断方法、病理学特点、治疗手段及影响预后的因素。方法：回顾性分析1998～2007年期间收治的6例原发性肾肉瘤患者的临床资料：男5例，女1例，年龄39～72岁，平均58岁。左肾肿瘤3例，右肾肿瘤3例。表现为腹痛3例，腹部包块1例，阴囊坠胀1例，无症状1例。肿瘤直径2．5～13cm·平均8．1cm。T1N0M0期2例，T2T0M0期1例，L3bN1M0期1例，T4NxM1期2例。6例患者术前影像学资料均诊断为肾脏恶性肿瘤。2例T1N0M0期、1例T2N0M0期及2例T1N0M1期患者均行肾癌根治术，1例T3bN1M0期患者行肾脏姑息性切除术。4例术后实施化疗。结果：术后病理检查示平滑肌肉瘤5例，癌肉瘤1例。术后3例随访6个月～3年，其中1例（T2N0M0）于术后2年发现腹膜后转移，并于术后3年死亡，1例（T4NxM1）于术后2个月发现双肺转移，1例（T1N0M0）无瘤存活。结论：腹痛及包块是肾肉瘤的常见症状，其恶性程度高，预后差。病理分期是影响预后的重要因素。手术是其主要治疗方式，术后是否化疗尚存在争议。     

局部进展期乳腺癌新辅助化疗后保乳手术31例报告

目的探讨局部进展期乳腺癌新辅助化疗降期后保乳手术治疗的可行性。方法2002年1月-2005年6月我院接受新辅助化疗后行保乳治疗的31例局部进展期乳腺癌。化疗方案：①TE：表阿霉素60mg／m^2，紫杉醇150mg／m^2，21d为1个周期；②CEF：表阿霉素60mg／m^2，环磷酰胺600mg／m^2，5-FU600mg／m^2，21d为1个周期，共3～4周期。在新辅助化疗完成后，临床体检、B超和钼靶乳房x线检查评估新辅助化疗疗效，符合保乳条件且病人有保留乳房的愿望可接受保乳治疗。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。术后常规行辅助放疔、化疗和内分泌治疗。结果新辅助化疗总有效率（overaul response rate，ORR）90．3％（28／31）；临床完全缓解（complete response，CR）25．8％（8／31），其中病理完全缓解（pathologic complete response，pCR）4例（12．9％，4／31），临床部分缓解（partial response，PR）20例（64．5％，20／31），无进展病例。经过34个月中位随访期（4～46个月），局部复发率6．5％（2／31）；3例术后发生远处转移，转移部位分别为肺、肝脏、脑膜和骨，远处转移率9．7％（3／31），其中1例死亡。对保乳综合治疗结束后满1年的25例进行乳腺外形的评估，外形优16．0％（4／25），良40．0％（10／25），差44．0％（11／25）。结论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。     

新辅助化疗对局部晚期乳腺癌的疗效分析

目的探讨新辅助化疗对局部晚期乳腺癌的疗效。方法对56例行新辅助化疗的局部晚期乳腺癌患者的临床资料进行总结分析。56例患者中ⅢA期30例，ⅢB期15例，ⅢC期11例。采用AC方案（环磷酰胺600mg/m^2静脉滴注，阿霉素60mg/m^2或表阿霉素90mg/m^2静脉滴注，第1日，21d为1个周期）或ET方案（表阿霉素90mg/m^2静脉滴注，第1日；多西他塞75mg/m^2静脉滴注，第2日；地塞米松16mg/d，第1-3日口服，21d为1个周期）。化疗3-4个周期后观察疗效，结果全部患者临床有效率（完全缓解＋部分缓解）为71.5%（40/56例），临床获益率（完全缓解＋部分缓解＋病情稳定）为95.4%，病理完全缓解率8.9%（5/56例）。38例（67.9%）重获根治手术机会，中位随访时间40个月，总生存率为62.5%（35/56例），无瘤生存率为39.3%（22/56例）。结论新辅助化疗能降低局部晚期乳腺癌术前TNM分期，使部分患者重获根治性手术机会。     

新辅助联合治疗在低位直肠癌的应用及存在的问题

目的探讨新辅助联合治疗（术前放化疗）、全直肠系膜切除（total mesorectal excision,TME）在局部进展期低位直肠癌的治疗效果。方法2003年1月至2007年12月,将49例T3、T4期的低位直肠癌给予放疗总剂量44~50Gy,每次2Gy,每周5次,共5周 同时常规给予5-FU＋MMC持续静脉滴注,放疗结束后休息6周进行手术。手术均按TME操作规范进行。结果全部病例均按计划完成新辅助联合治疗,放化疗的副反应发生率为26.5%（3/49）,3例肿瘤完全消失,未行手术。46例施行了根治性切除术,40例为保肛手术,6例为腹会阴切除术,故全组保肛率为87.8%（43/49）。已切除的标本病理结果显示8例肿瘤消失（T0）,总肿瘤消失为11例。辅助治疗后TNM分期：T0N0M011例,T2N0M022例,T3N0M04例,T2N1M07例,T3N1M04例,T4N1M11例,共40例（81.6%）达到降期。全组均获随访,中位随访时间24（6~38）个月。1例（2.0%）局部复发,1例（2.0%）肝转移,无死亡,3例未行手术的患者随访8~26个月至今,仍未发现肿瘤复发。结论新辅助联合治疗与TME相结合能有效地提高肿瘤的切除率和保肛率,降低局部复发率,达到肿瘤降期的目的,进一步降低了术后复发的风险,其远期疗效尚待进一步观察。     

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。     

腋下副乳腺癌4例诊治分析

目的探讨腋下副乳腺癌的临床特点、诊断及治疗方法。方法对我院1986～2000年期间收治的4例副乳腺癌患者的临床资料进行回顾性分析。结果4例均行乳腺癌改良根治术或根治术，术后辅以放、化疗。随访资料表明，1例Ⅱ期患者术后3年死于肿瘤广泛转移，1例Ⅲ期患者术后8个月肿瘤局部复发，另2例Ⅲ期患者分别存活4年及10年。结论手术为腋下副乳腺癌的首选治疗手段，术后应辅以放、化疗及内分泌治疗。为改善预后．应提高对此病的重视并及时行手术活检以明确副乳腺包块性质。     

进行性吞咽困难3月余

对1例主诉为“进行性吞咽困难3月余”的病例进行讨论。该例患者胃镜检查发现食管癌,既往患有风湿性心脏病．二尖瓣关闭不全伴狭窄、心房血栓和心房纤颤10余年。患者入院后行CT及PET—CT等检查,诊断为食管胸下段癌cT4aN1MoG2,IUC期。经多学科讨论认为,该患者肿瘤外侵明显、伴多发淋巴结肿大,局部晚期,无法达到R0切除．加之既往心脏病史,暂不宜手术。可先行全身化疗,同时予以口服抗凝药物并监测血常规及凝血功能。故给予患者新辅助化疗4周期,具体方案：紫杉醇75mg／m^2第1天、第8天、第15天,顺铂75mg／m^2第1—3天,28d为1周期。化疗结束后评估肿瘤分期为cyT2N1M0G2,IIB期,遂进一步子手术治疗．采用经裂孔食管切除术以减少对心脏的干扰。术后病理分期：ypT0N0M0G20期,随访15个月未见复发。     

肌层浸润性膀胱癌保留膀胱手术后不同辅助治疗方法的疗效评价

目的探索保留膀胱手术＋动脉灌注化疗＋膀胱内灌注化疗治疗肌层浸润性膀胱癌的临床疗效。方法对经尿道膀胱肿瘤电切或膀胱部分切除术后确诊为肌层浸润性膀胱癌（T2N0M0）的168例患者,充分向患者及其家属介绍病情和治疗建议,对拒绝或不适合膀胱全切的患者经患者及其家属同意,均采用保留膀胱治疗方法,分为3个治疗组：（1）综合治疗组：68例,术后采用动脉灌注化疗＋膀胱灌注化疗;（2）动脉灌注化疗组：48例,术后仅采用动脉灌注化疗;（3）膀胱灌注化疗组：52例,术后仅采用膀胱灌注化疗。结果168例膀胱癌（T2N0M0）患者,观察期内,综合治疗组患者中92．65％（63／68）无复发及转移,7．45％（5／68）分别在术后6、8、12、18、20个月复发,2．94％（2／68）在术后6、13个月出现全身多处转移死亡,11．76％（8／88）非膀胱癌导致死亡。动脉灌注化疗组患者中79．17％（38／48）无复发及转移,20．83％（10／48）在术后1～28个月复发,4．17％（2／48）在术后9、18个月出现全身多处转移死亡,12．50％（6／48）非膀胱癌导致死亡。膀胱灌注化疗组患者中44．23％（23／52）无复发及转移,55．77％（29／52）在术后1～24个月复发,15．38％（8／52）在术后10～96个月转移而死亡,13．46％（7／52）非膀胱癌导致死亡。3组疗效按复发率任何两组间比较,均有统计学差别（P均〈0．05）。3组疗效按癌性死亡率任何两组间比较,综合治疗组与动脉灌注化疗组相比,差异无统计学意义（P均〉O．05）;综合治疗组、动脉灌注化疗组均低于膀胱灌注化疗组,差异均有统计学意义（P均〈O．05）。3组患者分组治疗后非膀胱癌导致死亡率任何两组间比较,无统计学差异（P均〉o．05）。结论肌层浸润性膀胱癌（T2N0M0）患者,采用保留膀胱手术＋髂内动脉灌注化疗＋膀胱内灌注化疗的综合治疗方法,能有效减少肿瘤复发、预防转移、提高患者的生活质量,患者易于接受,值得进一步探讨。     

不可手术的局部晚期乳腺癌的治疗

<正>局部晚期乳腺癌的分期评估为临床ⅢA(T3N1M0除外)、ⅢB或ⅢC期。对于表现为不可手术的、非炎性乳腺癌的局部晚期乳腺癌患者,标准的治疗是以蒽环类为基础±紫杉类的化疗方案作为术前初始治疗。术前化疗获得临床效果后的局部治疗包括:(1)全乳切除+Ⅰ/Ⅱ级腋窝淋巴结清扫,联合或不联合延迟乳房重建;(2)肿块切除+Ⅰ/Ⅱ级腋窝淋巴结清扫。     

胃癌急性穿孔临床病理分期的特点以及手术方式

【摘要】 目的：分析评价胃癌穿孔的临床病理分期特点和治疗策略。方法：对我院 2000年1月至2011年10月收治的44例胃癌急性穿孔患者的临床资料进行回顾性分析。分析不同的临床病理分期和治疗对策的相关性以及对预后的影响。结果：44例胃癌穿孔患者临床病理分期II 期(T4aN0M0 2例)2例,Ⅲ期(T4aN1-2M0 5,T4bN0-1M0 14例)19,IV期 (T4aN1-3M1 7额,T4bN1-3M1 16例) 23 例,穿孔更多见于胃癌的III–IV 期,均侵犯浆膜或浆膜外（T4a-b）。16例（36.4%）行单纯穿孔修补术,其中Ⅲ期6例,IV期10例,16例（36.4%）行姑息性切除术,其中Ⅲ期6例,IV期10例,4例（9%）根治性切除术中,II 期1例,Ⅲ期3例,另外8例（18.2%）按损伤控制外科（DCS）原则行简单修补术后2周内行根治性胃切除术,其中II期1例,Ⅲ期4例, IV期3例,结论：胃癌穿孔常发生于进展期胃癌,其治疗策略以根治性手术或姑息性切除为主。     

High-Dose Chemotherapy with Peripheral Blood Stem Cell Support for Operable Locally Advanced Noninflammatory Carcinoma of the Breast

▪ Abstract: The purpose of this study was to determine outcomes for patients with operable noninflammatory stage IIIA/B locally advanced breast cancer (LABC) with positive axillary lymph nodes receiving high-dose chemotherapy (HDC) with peripheral blood stem cell (PBSC) support. One hundred fifteen patients with LABC who were no evidence of disease (NED) after initial surgery received standard dose induction chemotherapy, chemotherapy for mobilization of PBSC, and high-dose cyclophosphamide, thiotepa, and carboplatin with PBSC support for adjuvant therapy. Following hematopoietic recovery, all patients were scheduled to receive radiation therapy and tamoxifen was administered if the primary tumor was estrogen receptor/progesterone receptor (ER/PR) positive. Eighty-eight percent of patients were admitted to the hospital following HDC for a median of 11 days (range 3–26) and 12% were treated entirely as outpatients. There was one treatment-related death (0.9%) from infection occurring on day 8 after HDC. Forty-four (38%) have relapsed at a median of 20 months (range 10–55) from diagnosis, 11 (10%) with local-regional and 33 (28%) with metastatic disease. The probabilities of overall (OS) and event-free survival (EFS) for all 115 patients at 3 years were 0.73 and 0.61, respectively, with a median follow-up of 42 months (range 10–89) from diagnosis. In univariate and multivariate analyses, no factors could be identified that were statistically predictive for OS or EFS. However, there were trends for patients with ER/PR-negative primary tumors to have worse OS (p = 0.16) and EFS (p = 0.10) than patients with ER/PR-positive tumors. This adjuvant combined modality strategy incorporating HDC is safe and compares favorably to historical studies of neoadjuvant or adjuvant treatment for LABC. Further attempts to improve outcomes of patients with LABC receiving HDC are warranted. ▪     

Complete response after high-dose chemotherapy and autologous hemopoietic stem cell transplatation in metastatic breast cancer results in survival benefit

Metastatic breast cancer is an incurable disease even with high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (ASCT). Even though phase III studies have not shown a survival advantage for this group as a whole, it is possible that a small subset of patients may benefit from HDC/ASCT with careful patient selection. A total of 198 patients from three different institutions were treated with HDC/ASCT. After complete staging, patients with central nervous system or bone marrow involvement were excluded. The HDC regimen consisted of: Carboplatin 600 mg/m(2) IV infusion over 48 hours, Thiotepa 300 mg/m(2) IV infusion over 2 hours, and Cytoxan 60 mg/kg IV infusion given over 2 hours x3 days. The median age at the time of transplant was 46 (24-62) years and median follow-up was 20 months. Hormone receptor status was known in 148 patients, of whom 84 had estrogen receptor (ER) and/or progestrone receptor (PgR)-positive tumors. Eighty patients had no evidence of disease at the time of HDC/ASCT (CR1). At the completion of HDC and ASCT, complete responses (CR) were seen in an additional 57 patients (CR2). Using Kaplan-Meier analysis, the median relapse-free survival (RFS) for the entire group was 15 months and overall survival (OS) was 27 months. The patients in CR1 had a median RFS and OS of 20.7 and 50.6 months, respectively. This was very similar to the RFS and OS in patients achieving CR2 after HDC/ASCT (p < 0.001; median: 19 and 40 months, respectively). In contrast, the patients with persistent residual disease had an RFS and OS of 7 and 12 months (p < 0.001). These data show that patients achieving a CR after HDC/ASCT have a better relapse-free and OS, when compared to patients with persistent residual disease after HDC/ASCT. This study suggests that a subset of patients with residual metastatic breast cancer after standard chemotherapy can achieve CR with HDC and ASCT which may result in better long-term outcome.     

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。     

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。     

Immediate breast reconstruction for stage III breast cancer using transverse rectus abdominis musculocutaneous (TRAM) flap

Background: The management of stage III breast cancer is challenging; it often includes multimodal treatment with systemic therapy and/or radiation therapy and surgery. Immediate breast reconstruction has not traditionally been performed in these patients. We review the results of immediate transverse rectus abdominis musculocutaneous (TRAM) flap in 21 patients treated for stage III breast cancer. Methods: Data have been collected retrospectively on 21 patients diagnosed with stage III breast cancer between 1987 and 1994. All patients had mastectomy and immediate TRAM reconstruction. Thirteen patients received primary systemic therapy, 10 patients received postoperative consolidation radiotherapy to the operative site, and 3 patients received preoperative radiation. Results: Mean follow-up for the group was 26 months. Two patients died with disseminated disease: neither of them developed local disease recurrence in the operative site; 82% of the patients followed for at least two years are free of disease. Sixty-two percent of the patients received preoperative chemotherapy, the remaining patients received postoperative multiagent chemotherapy and/or radiation therapy. Two of the patients received autologous bone marrow transplants after their adjuvant therapy. Ten patients had postoperative radiotherapy for consolidation; three patients received preoperative radiation. Conclusions: Immediate TRAM reconstruction for stage III breast cancer is not associated with a delay in adjuvant therapy or an increased risk of local relapse. It facilitates wide resection of involved skin without skin grafting. Radiation therapy can be delivered to the reconstructed breast when indicated without difficulty. Breast reconstruction facilitates surgical resection of stage III breast cancer with primary closure and should be considered if the patient desires immediate breast reconstruction.Results of this study were presented at the 48th Annual Cancer Symposium of The Society of Surgical Oncology, Boston, Massachusetts, March 23–26, 1995.     

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。     

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.     

The role of postoperative radiation therapy in stage I–III male breast cancer: A population-based study from the surveillance,epidemiology, and End Results database

BackgroundThis study aimed to investigate the role of postoperative radiation therapy in a large population-based cohort of patients with stage I–III male breast cancer (MaBC).MethodsPatients with stage I–III breast cancer treated with surgery were selected from the Surveillance, Epidemiology, and End Results cancer database from 2010 to 2015. Multivariate logistic regression identified the predictors of radiation therapy administration. Multivariate Cox regression model was used to evaluate the predictors of survival.ResultsWe identified 1321 patients. Age, stage, positive regional nodes, surgical procedure, and HER2 status were strong predictors of radiation therapy administration. There was no difference between patients who received radiation therapy and those who did not (P = 0.46); however, after propensity score matching, it was associated with improved OS (P = 0.04). In the multivariate analysis of the unmatched cohort, the factors associated with better OS were administration of radiation therapy and chemotherapy. In the subset analysis of the unmatched cohort, postoperative radiation therapy was associated with improved OS in men undergoing breast-conserving surgery (BCS), with four or more node-positive or larger primary tumours (T3/T4). Furthermore, we found no benefit of radiation therapy, regardless of the type of axillary surgery in mastectomy (MS). In older MaBC patients with T1-2N1 who underwent MS, radiation therapy showed no significant effects, regardless of chemotherapy.ConclusionPostoperative radiation therapy could improve the survival of MaBC patients undergoing BCS, with four or more node-positive or larger primary tumours. Moreover, it should be carefully considered in patients undergoing MS and older T1-2N1 patients.     

早期乳腺癌的保乳综合治疗疗效分析

目的　评价早期乳腺癌保乳综合治疗的疗效。方法　保乳组 92例 ,行保留乳房的肿瘤切除加腋窝淋巴结清扫术 ;对照组 60例 ,行乳癌改良根治术。术后给予放疗、全身化疗和 /或内分泌治疗。结果　平均随访 5 7个月 ,保乳组中无局部复发病例 ,3年生存率为 97.2 % ,5年生存率为 89.3 % ,远隔脏器转移率为 6.5 % ;对照组局部复发 2例 ,3年生存率为 97.5 % ,5年生存率为90 .1% ,远隔脏器转移率为 5 .0 % ,两组各指标对比无明显差异 (P >0 .0 5 )。结论　早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 ,可作为首选方法     

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.