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。     

Radical mastectomy with parasternal node dissection or radiation to the parasternal region for breast cancer of medial or central location

In order to establish a therapeutic approach for primary breast cancer of medial and central origin, we reviewed 183 patients who had been treated by one of the following three modalities at the Second Department of Surgery, Osaka University Medical School between January, 1965 and December, 1980. Group A (n=70): standard radical mastectomy alone; Group B (n=34): standard radical mastectomy followed by postoperative irradiation to the parasternal and supraclavicular regions, and; Group C (n=62): extended radical mastectomy that included removal of the parasternal lymph nodes. The background factors of the three groups were not significantly different. The overall survival five and ten years following surgery in the three groups were 91 per cent and 79 per cent in group A, 82 per cent and 67 per cent in group B, and 82 per cent and 70 per cent in group C, respectively, showing no significant difference in overall survival among the three groups. When the patients were classified according to the extent of axillary lymph node involvement, there was no difference in survival among the three treatments in patients who had less than three lymph node metastases in the axilla. However, treatment of the parasternal lymph nodes improved survival in the patients who had more than four lymph node metastases in the axilla. Parasternal lymph node involvement definitely worsened the prognosis, showing it to be a good prognostic factor. Thus, extended radical mastectomy should be considered for patients with breast cancer of medial or central location, when extended axillary lymph node involvement is found.     

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     

Multimodal therapy in locally advanced breast carcinoma

Among 879 patients treated for breast cancer between 1975 and 1984, advanced disease was found in 125 (14%). A subgroup of 34 (4%) presented with untreated locally advanced disease without demonstrable distant metastases at the time of diagnosis (stage IIIB = T4abed, NX-2,MO). During the first 5 years (1975 through 1979), 17 patients were treated primarily with sequential radiotherapy and chemotherapy (Group A). From 1980 to 1984 (Group B), the management consisted of four courses of induction multi-drug chemotherapy followed primarily by mastectomy and additional chemotherapy. The mean follow-up for the most recent group (Group B) is 48 months. Follow-up was complete. While the local disease control rate was the same for both groups (76%), the survival was remarkably different. Group A patients experienced a median survival of 15 months, and only one survived 5 years. In Group B, the median survival was 56 months with nine patients (53%) alive between 40 and 76 months, seven (41%) of whom are 5-year survivors. While the overall mortality of patients with inflammatory breast cancer was greater in both groups when compared with the group with noninflammatory disease, the survival of patients in Group B was better than in Group A for both inflammatory and noninflammatory cancers (p less than 0.01). Estrogen receptor, nodal, and menopausal status did not influence survival. These data suggest that neoadjuvant chemotherapy improves survival for patients with stage IIIB breast carcinoma and delays the establishment or progression of distant metastases. Mastectomy is an important component in the treatment of this disease.     

新辅助化疗对ⅡB期乳腺癌的疗效对比研究

目的 研究新辅助化疗治疗ⅡB期乳腺癌的临床作用.方法 选取2002年1月至2004年11月ⅡB期女性乳腺癌330例,全部单侧患病,随机分成2组.新辅助化疗组152例(年龄32～73岁,平均42.6岁;左侧78例,右侧74例),给予紫杉类、蒽环类为主的联合化疗,每2个周期后评价疗效,4个周期后实施手术.非新辅助化疗组17...     

Male breast carcinoma

Fifty men with primary breast carcinoma were seen between the years 1938 and 1983 at the University of Iowa Hospitals and Clinics. In most patients, there was a significant delay between the onset of symptoms and seeking medical advice (mean, 21 months; range, 1-156). The vast majority of patients were treated by simple, modified radical, or radical mastectomy. Ten patients underwent incisional or excisional biopsy with or without radiation because of locally advanced disease or distant metastases. Survival was comparable in the groups of patients treated with simple mastectomy (mean, 70 months), modified radical mastectomy (mean, 61 months), and radical mastectomy (mean, 78 months). Local recurrence occurred in 25 per cent of all patients, and this rate was not dependent on the operation performed. The data suggest that modified radical mastectomy is adequate therapy for local control and staging of the disease without reducing survival from that observed after radical mastectomy.     

根治术与改良根治术治疗早期乳腺癌的疗效比较

目的比较根治术与改良根治术治疗早期乳腺癌的疗效。方法回顾性分析Ⅰ、Ⅱ期乳腺癌患者行根治术者60例,改良根治术者84例的临床资料。结果改良组术后胸壁形态、患肢功能、患肢肿胀、皮瓣坏死的发生率均优于根治术组(P<0.05)。改良根治术组5年生存率Ⅰ期97.3%,Ⅱ期95.5%,根治术组5年生存率Ⅰ期95.7%,Ⅱ期94.3%,两组比较无明显差异(P>0.05)。结论采用改良根治术治疗乳腺癌生存率与根治术无异,但可明显提高患者生存质量。     

307例女性乳腺髓样癌报告

本文总结了３０７例经治的中国女性乳腺髓样癌。根据Ｒｉｄｏｌｆｉ等制定的诊断标准（ｃａｎｃｅｒ，１９７７，４０：１３６５～１３８６），分为９２例（２９．９％）典型髓样癌和２１５例（７０．０％）非典型髓样癌。结果表明９２例典型髓样癌和２１５例非典型髓样癌的１０年生存率分别为８４．８％（７８／９２）和７３．０％（１５７／２１５）。腋窝淋巴结的转移情况被认为是影响预后的重要因素，在腋窝淋巴结无转移组５６例典型髓样癌和１１４例非典型髓样癌的１０年生存率分别为９２．９％（５２／５６）和８６．０％（９８／１１４），而在腋窝淋巴结有转移时分别为７２．２％（２６／３６）和４９．５％（５０／１０１）。乳腺髓样癌具有良好的组织学特征和预后效果，特别是腋窝淋巴结阴性的典型髓样癌的预后效果最佳。     

Adenoid cystic carcinoma of the breast. Data from the Connecticut Tumor Registry and a review of the literature.

The case records of the Connecticut Tumor Registry were reviewed from 1952-1982. There were 37 cases of adenoid cystic carcinoma of the breast (ACC) from a total of 40,350 invasive breast tumors. Patient survival, complications, and pathologic sections were reviewed. Only 14 of 27 surgical pathology slides available for review could be confirmed histologically as ACC. All patients were white females with a mean age of 64 years. The tumor remained localized to the breast in all cases. Nine patients had either radical or modified radical mastectomy, four patients had either simple mastectomy or lumpectomy, and one patient refused treatment. There was no evidence of axillary node involvement, metastases, or local recurrence after excision. At the time of follow-up, nine patients were alive and disease free and four died of disease unrelated to their breast cancer. The one patient who died of breast cancer had a radical mastectomy and survived 11.7 years after diagnosis. It is concluded that ACC has a favorable biologic behavior characterized by a prolonged clinical course and good prognosis. Simple mastectomy is all that is required as initial treatment, and a chest x-ray and thorough physical examination looking for local recurrence is all that is needed for follow-up.     

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。     

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.     

乳腺癌改良根治术后背阔肌皮瓣联合假体一期乳房重建(附20例报告)

目的:探讨乳腺癌改良根治术后使用背阔肌皮瓣联合假体一期乳房重建的方法及疗效。方法:自2010年5月至2013年12月,20例乳腺癌(TNM分期0期3例,Ⅰ期12例,Ⅱ期5例,乳腺导管内癌3例,乳腺浸润性导管癌17例)行改良根治术,同时采取一期背阔肌皮瓣联合假体乳房重建术。结果:20例乳房一期重建均获成功,无积液、感染、坏死等并发症,重建乳房外形美观。随访16(6~38)个月,无复发和转移。结论:乳腺癌改良根治术后一期乳房重建安全性高,操作简单易行,外形良好,提高了乳腺癌病人术后的生活质量,是理想的乳房重建方式。     

Role of surgery in the treatment of inflammatory breast carcinoma

Twenty-eight patients with inflammatory carcinoma of the breast have been retrospectively reviewed. Overall 5 year survival was 25 percent. There was a trend toward improved survival in patients who received chemotherapy which did not achieve statistical significance. Sixteen patients underwent mastectomy as part of their treatment. These patients had a 48 percent 5 year survival which was significantly better than the survival in patients who did not undergo mastectomy. Furthermore, mastectomy resulted in better control of the local disease. Of 12 patients who did not undergo mastectomy, local control was initially obtained in only 2, and both of these patients suffered local recurrence within 1 year. Our data support the conclusion that mastectomy be combined with preoperative and postoperative multiagent cytotoxic chemotherapy in the treatment of inflammatory carcinoma of the breast. More precise staging may permit better prognostic stratification of patients with this highly malignant cancer.     

乳腺癌改良根治术同期乳房重建的安全性和患者满意度评价

目的观察乳腺癌改良根治术同期行背阔肌肌皮瓣乳房重建的临床效果,评价患者满意度。方法选择病理确诊的乳腺癌患者22例(重建组),行腺癌改良根治术并同期行背阔肌肌皮瓣乳房重建术;匹配同龄、同学历、同TNM肿瘤分期的非乳房重建患者22例作对照(对照组),以Harris标准评价重建乳房的美容效果。随访3年,观察癌组织局部复发转移情况;对患者术后6个月、12个月、24个月和36个月的满意度进行评价。结果两组3年均无肿瘤局部复发及远处转移。乳房重建组优、良、一般分别为14例、5例和3例,患者满意度高于对照组(P0.05),时间因素和分组因素无交互作用(P>0.05)。结论乳腺癌改良根治术同期行背阔肌肌皮瓣乳房重建,不但保证了肿瘤治疗的效果,而且患者的形体美,满意度高。     

Carcinoma of the male breast. Prognostic factors and outcome of surgical treatment

A retrospective study was made on 18 male patients with breast carcinoma treated at the Department of Surgery "Pietro Valdoni" of the University "La Sapienza" of Rome, Medical School. Demographics, pathology, stages, and treatment were determined from clinical reports. All patients but one underwent modified radical mastectomy. The length of follow up averaged 57.5 months. Five years actuarial survival rate was 62%. In the current study the Authors suggest that the clinical, prognostic and treatment features of breast carcinoma in men are similar to those reported in literature for post-menopausal women.     

Intraoperative implantation radiation therapy plus lumpectomy for carcinoma of the breast

The preponderance of evidence indicates that lumpectomy plus radiation therapy produces the same survival as modified radical mastectomy in patients with early breast cancer and further suggests that the local failure rate may be lower in the patients who undergo irradiation. In this series, patients were treated with immediate implantation of the tumor bed with iridium Ir 192. There have been two recurrences in the breast from 110 breast cancers (44% had a clinical stage greater than T1, and 41% had axillary-node involvement) in 107 patients followed up for four to 52 months (25.8 +/- 13.3 months [mean +/- SD]). These preliminary data suggest that local treatment failure can be minimized by aggressive, immediate intraoperative implantation of the tumor bed with iridium Ir 192.     

The Role of Contralateral Prophylactic Mastectomy in Invasive Lobular Carcinoma

Abstract: Invasive lobular carcinoma has been associated with an increased risk of contralateral breast disease. Controversy exists regarding the use of contralateral prophylactic mastectomy versus careful observation of the contralateral breast. Our objective was to determine the incidence of occult cancer in the contralateral breast and to assess whether contralateral prophylactic mastectomy improves patient survival. We retrospectively reviewed the charts of 133 patients treated surgically for invasive lobular carcinoma between January 1, 1978, and December 31, 1993. The median age was 54 years (range, 24–82 years). The distribution of patients by stage was as follows: stage 1, 29%; stage IIa, 36%; stage IIb, 20%; stage IIIa, 11%; stage IIIb, 3%; and unknown, 1%. The median follow-up was 68 months (range, 13–178 months). Group comparisons were performed using log-rank analysis and survival curves were constructed by the method of Kaplan and Meier. Eighteen patients underwent contralateral prophylactic mastectomy. Among these patients there were no cases of invasive cancer and only 3 (17%) cases of lobular carcinoma in situ in the contralateral breast. Three patients who underwent contralateral prophylactic mastectomy later developed distant metastases from the original ipsilateral breast cancer. Of the 115 patients managed conservatively, 3 (3%) developed contralateral disease at 11, 34, and 101 months. Twenty-five patients developed distant disease. Overall survival in the contralateral prophylactic mastectomy group did not differ significantly from the group treated conservatively (p = 0.90). We conclude that careful observation with a yearly mammogram and physical examination of the contralateral breast is appropriate management for patients with invasive lobular carcinoma.     

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.     

Influence of mastectomy technique on sex steroid receptor analysis

Accurate analysis of hormone receptors in breast carcinoma is critical from prognostic and therapeutic standpoints. Controversy exists over whether there is receptor decay when specimens are obtained upon completion of, rather than prior to, mastectomy. In addition, the effect of mastectomy technique on receptor concentration has not been addressed. Twenty patients with breast carcinoma had biopsy specimens taken prior to and upon completion of modified radical mastectomy. Ten had axillary dissection followed by mastectomy (Group A). The others had mobilization of the breast before axillary dissection (Group B). The estrogen receptor concentration was higher in 14 of 20 premastectomy specimens. All 10 patients in Group B had positive receptors before mastectomy; 5 were negative after mastectomy. All seven patients in Group A with positive premastectomy receptors remained so postmastectomy. We concluded that if a tumor specimen for receptor analysis is not obtained prior to modified radical mastectomy, axillary dissection should precede breast mobilization.     

Trend towards conservative surgery for intraductal carcinomas of the breast. (Retrospective study of 165 cases)]

One hundred and sixty-five intraductal, non invasive breast carcinomas in 162 patients were reviewed. The mean follow-up was 75 months. Recurrence rates seem to be influenced by the therapeutic approach: 4.8% following mastectomy (4 cases out of 83); 16% following breast conserving surgery associated with radiotherapy (4 cases of 25); 22.8% following subcutaneous mastectomy (8 cases out of 35); 50% following breast conserving surgery alone (11 cases out of 35). When considering the clinical and radiological sizes of the tumor in the group of tumor excision and breast irradiation, additional information is gained. When the size is less than 25 mm the recurrence rate drops to 6.6% (1 case out of 15). When the lesions are extensive a subcutaneous mastectomy followed by irradiation (with or without a breast implant) might be an interesting alternative to modified radical mastectomy.