Ⅱ期和ⅢA期可手术乳腺癌新辅助化疗的疗效观察

目的 探讨Ⅱ期和ⅢA期(仅指T3N1M0)可手术乳腺癌新辅助化疗的效果,评价新辅助化疗在Ⅱ、ⅢA期乳腺癌治疗中的价值;初步探讨肿瘤大小与病理完全缓解的关系;初步分析新辅助化疗的应用选择.方法 回顾分析北京友谊医院普外科收治的可手术乳腺癌临床病例共408例,分为A组(新辅助化疗组)及B组(对照组),A组Ⅱ期106例、ⅢA期112例,B组Ⅱ期92例、ⅢA期98例,A组应用新辅助化疗4个周期,随后进行手术,术后辅助化疗、放疗.B组不做任何形式的术前辅助治疗,手术和术后其他治疗与A组相同,比较两组的近期疗效、术式选择、局部控制率和5年生存率.结果 A组Ⅱ期可保乳率由23.6％提高到49.1％ (P=0.000),两组Ⅱ期5年总生存率和无瘤生存率差异无统计学意义(P =0.939、0.858);A组ⅢA期患者5年总生存率(59.8％)和无瘤生存率(51.8％),均高于B组(35.7％、27.6％)(P=0.000、0.000);3年局部复发转移率A组(7.9％)低于B组(18.4％)(P＜0.05);肿瘤小于3.0 cm易达到病理完全缓解(P =0.001),预后情况好(P=0.000).结论 新辅助化疗可提高Ⅱ、ⅢA期可手术乳腺癌患者的保乳率、降低局部复发转移率;可提高ⅢA期乳腺癌患者的5年生存率;新辅助化疗能达到临床和病理完全缓解患者5年总生存率和无瘤生存率更高;肿瘤大小是影响乳腺癌新辅助化疗病理完全缓解的独立因素,病灶小易达到完全缓解.     

新辅助化疗对乳腺癌患者胰岛素样生长因子-1受体表达的影响

目的 探讨新辅助化疗对乳腺癌组织中胰岛素样生长因子-1受体(insulin-like growth factor-1 receptor,IGF-1R)表达的影响,以有助于乳腺癌治疗的选择及预后判断.方法 通过免疫组化SP法检测40例Ⅱ/Ⅲ期乳腺癌患者在化疗前、后乳腺癌组织中IGF-1R表达的情况.术前采用空心针穿刺活检予以病理确诊并行IGF-1R表达的测定.化疗方法统一采用TAC方案(多西他赛、表柔比星及环磷酰胺),经过2个疗程的化疗,再行乳腺癌改良根治术,比较化疗前、后IGF-1R表达的变化.新辅助化疗的临床疗效通过体检和乳腺B超测量肿瘤的最大直径,按WHO的统一判定标准来评价.结果 40例Ⅱ/Ⅲ期乳腺癌患者经2个周期的新辅助化疗后,29例(72.5%)获得了部分缓解,无完全缓解病例,无进展病例.化疗后25例IGF-1R由高表达变为低表达(P＜0.01).结论 新辅助化疗可能部分通过抑制IGF-1R的表达来抑制乳腺癌的增殖.     

晚期乳腺癌新辅助化疗的临床报告

目的　探讨新辅助化疗在晚期乳腺癌治疗中的远期临床效果。方法　对 31例Ⅲ、Ⅳ期的乳腺癌患者行新辅助化疗 ,手术前行 2周期的CAF方案化疗〔CTX 5 0 0mg/m2 静脉推注 (第 1、8天 ) ,5 FU 5 0 0mg/m2 静脉推注 (第 1、8天 ) ,ADM 30mg/m2 静脉推注 (第 1天 ) ,每 2 1天为 1周期〕 ,并与同期未行任何术前治疗的可手术的30例Ⅲa期患者作对比分析。结果　新辅助化疗组的总有效率为 87.1% (2 7/31) ,有 6 1.3% (19/31)的患者分期降低 ,其中 6例降为Ⅲa期 ,8例降为Ⅱb期 ,4例降为Ⅱa期 ,1例降为 0期 ,临床完全缓解 1例 ,无病理完全缓解。新辅助化疗组的无病生存期为 5 6 .3个月 ,明显高于未行化疗组的 4 3.5个月 (P<0 .0 5 ) ,新辅助化疗组的 5年无病生存率为 38.7% ,略高于未化疗组的 33.3% ,两组间差异无显著性意义。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 ,能明显延长晚期乳腺癌患者的无病生存期 ,减少或延缓肿瘤的复发、转移。     

术前新辅助化疗在局部中晚期乳腺癌中的应用附30例报道

目的: 探讨局部中晚期乳腺癌新辅助化疗的临床意义. 方法: 应用CEF方案对30例Ⅱb-Ⅲ期乳腺癌患者进行新辅助化疗. 环磷酰胺(CTX) 600 mg/m2, d1, ;表阿霉素(EPI) 60mg/m2, d1,5-氟尿嘧啶(5Fu) 500 mg/m2, d1, 21d为1个周期,所有患者完成2个周期新辅助化疗后评价疗效.结果: 21例降低了临床分期;3例获得完全缓解(CR),18例部分缓解(PR),6例病情稳定,1例无效,总有效率(CR+PR)为70%. 结论: 进展期乳腺癌新辅助化疗对原发肿瘤和腋窝淋巴结均有较好疗效.     

乳腺癌患者新辅助化疗前后IGF-1的改变

目的探讨与分析乳腺癌患者胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)在新辅助化疗前后的改变情况。方法将2010年10月到2013年10月于我院接受新辅助化疗的40例乳腺癌患者作为研究对象,所有患者均采用新辅助化疗,持续4周期左右,并在间隔2周后施行乳腺改良根治手术,测定化疗前后患者血清中IGF-1表达水平。结果施行新辅助化疗前40例患者的IGF-1表达水平为(53.09±3.99)ng/ml,施行新辅助化疗3个周期后为(33.67±3.73)ng/ml,前后比较差异显著(P0.05)。年龄、TMN分期与IGF-1的浓度有关,无论化疗前后,年龄45岁者的IGF-1浓度高于≥45岁者,TMN分期Ⅲ期的IGF-1浓度高于Ⅱ期者。同时,化疗后IGF-1浓度均显著下降;化疗1、3、4个周期后,IGF-1浓度逐渐下降,且小于45岁者更为明显。结论乳腺癌患者血清IGF-1浓度与肿瘤的进展有关,可能有评估新辅助化疗疗效与预后的潜能。     

MRI及B超对乳腺癌新辅助化疗疗效评价的前瞻性研究

目的 观察B超及MRI在乳腺癌新辅助化疗疗效评价中的作用.方法 对2007年7月至2008年7月接受新辅助化疗的85例原发性乳腺癌患者进行前瞻性研究,对比分析手术前新辅助化疗前、化疗2周期后、化疗4周期后患者的B超、MRI影像学资料,参照实体瘤疗效评价标准(RECIST)评价疗效,并与术后组织病理学检查进行比较.结果 人组患者共85例,均完成4周期新辅助化疗.MRI评估完全缓解(CR)者0例,部分缓解(PR)者56例,疾病稳定(SD)者27例,疾病进展(PD)者2例;B超评估CR者0例,PR者52例,sD者31例,PD者2例.MRI及B超对新辅助化疗后残余肿瘤检测的阳性预测值均为94.1%.其中新辅助化疗后残余肿瘤最大径线MRI测茸结果与病理镜下测量结果高度相关(r=0.783,P<0.05),B超对残余肿瘤测量结果与病理镜下测量结果中度相关(r=0.576,P<0.001).结论 MRI是乳腺癌新辅助化疗临床疗效评价的可靠方法,其准确性高于B超.     

局部进展期乳腺癌新辅助化疗后保乳治疗的疗效观察

目的:探讨局部进展期乳腺癌新辅助化疗后保乳治疗的可行性及疗效.方法:对2006年2月-2009年3月62例Ⅱ,Ⅲ期乳腺癌患者给予CET方案化疗4～6周期后评估符合保乳条件行保乳治疗.分析新辅助化疗有效率及保乳术后的局部复发率、远处转移率、术后乳房美容效果等.结果:新辅助化疗有效率88.7％.符合保乳条件50例(80.6％,50/62).实际48例保乳成功.经40～81个月随访,同侧乳房复发率4.16％,远处转移率8.33％,乳房外形满意率87.5％.结论:局部进展期乳腺癌新辅助化疗后保乳治疗是可行的,严格把握适应证及精确的术前评估是成功的关键.     

国外医学文献摘要

新辅助化疗与辅助化疗治疗局部进展期乳腺癌(T4bN0～2M0)的疗效比较——一项随机对照研究DeoSV,BhutaniM,ShuklaNK,etal.JSurgOncol.2003,84(4):192鄄197.将101例可手术切除的局部进展期乳腺癌病人(T4bN0～2M0)随机分为新辅助化疗组和辅助化疗组,前者在手术前后分别接受3个周期     

金克槐耳对新辅助化疗乳腺癌患者细胞免疫功能的影响

目的 观察金克槐耳颗粒对行TAC新辅助化疗乳腺癌患者细胞免疫功能的影响.方法 60例乳腺癌患者随机分成新辅助化疗联合金克槐耳颗粒组(Ⅰ组,32例)及单用新辅助化疗组(Ⅱ组,28例).检测两组患者新辅助化疗前后细胞免疫功能指标.另设对照组30例,均为乳腺良性疾病患者.结果 化疗前Ⅰ,Ⅱ组CD3+,CD4+,CD4+/CD8+,NK均低于对照组(P＜0.05),而Ⅰ,Ⅱ组与对照组之问CD8+细胞差异无统计学意义(P＞0.05).Ⅰ组化疗后CD3+,CD4+,CD4+/CD8+和NK细胞均明显高于化疗前(P＜0.05),Ⅱ组化疗后各项指标与化疗前差异均无明显性(P＞0.05).Ⅰ组化疗后CD3+,CD4+,CD4+/CD8+和NK细胞均明显高于Ⅱ组(P＜0.05).结论 乳腺癌患者细胞免疫功能受到抑制,2周期TAc新辅助化疔对乳腺癌患者细胞免疫功能影响不大,联合使用金克槐耳颗粒能改善化疗后患者细胞免疫功能.     

新辅助化疗乳腺癌患者靶控输注依托咪酯意识消失时效应室靶浓度的EC50

目的 测定新辅助化疗后患者靶控输注(target-controlled infusion,TCI)依托咪酯意识消失时的半数效应室靶浓度(EC50).方法 90例ASA Ⅰ或Ⅱ级,同时期行乳腺癌切除手术的乳腺癌患者,根据术前是否接受新辅助化疗以及化疗方案分为未化疗组(Ⅰ组),紫杉醇化疗4周期组(Ⅱ组),药物联合化疗4周期...     

The predictive value of sentinel lymph node biopsy in locally advanced breast cancer patients who have undergone neoadjuvant chemotherapy

With the increasing usage of neoadjuvant chemotherapy (NAC) in locally advanced breast cancer (LABC), there is the need to investigate the routine axillary node dissections performed in this group of patients. Controversy exists about the utility of sentinel node biopsy (SNB), either before or after NAC. With the addition of trastuzumab in the treatment of Her2/neu-positive LABC patients, the validity of SNB in this subset population needs to be investigated. A retrospective study of 20 patients who underwent NAC for LABC was undertaken. The pathology of the axillary nodes, sentinel nodes, and primary tumor after neoadjuvant chemotherapy were examined. Twenty patients underwent NAC with doxorubicin and cyclophosphamide, followed sequentially by paclitaxel and carboplatin, with or without trastuzumab based on Her2/neu status. Post chemotherapy, 20 patients underwent mastectomy or lumpectomy with SNB with axillary node dissections. The overall accuracy of SNB was 95 per cent with a false-negative rate of 14 per cent (1/7). In Her2/neu-positive patients, overall accuracy was 100 per cent (8/8) and a false-negative rate of zero per cent. Sentinel node biopsy is a viable option in patients who have undergone NAC. Her2/neu-positive patients who had undergone NAC with trastuzumab had comparable accuracy for sentinel node biopsy in predicting axillary node status.     

乳腺癌新辅助化疗后蓝染法行前哨淋巴结活检术的临床分析

【摘要】 目的 研究乳腺癌患者新辅助化疗后蓝染法行前哨淋巴结活检术(SLNB)的可行性。方法〓回顾性分析2012年1月至2015年6月初诊于广西柳州市工人医院普外四病区的IIA-IIIB期乳腺癌患者69例。所有患者均接受新辅助化疗,疗程4~8个周期,分析新辅助化疗后蓝染法行SLNB的检出率、假阴性率。结果〓入组患者SLNB检出率为85.5%,假阴性率为18.2%;SLNB的检出率因腋窝淋巴结状态不同而存在统计学差异,在不同肿瘤的大小、肿瘤位置、患者年龄和SLNB时注射染料位置无统计学差异,假阴性率在上述不同分组中均无统计学差异。结论〓NAC后蓝染法SLNB可应用于治疗前腋窝淋巴结阴性的乳腺癌患者;对于治疗前腋窝淋巴结阳性的患者则存在风险。增加SLN检出数目可增加NAC后行SLNB的可靠性。     

Résultats à 10 ans d'un essai randomisé de chimiothérapie néo-adjuvante dans les cancers du sein de plus de 3 cm

Aim of the studyThe aim of this randomised trial was to determine advantages and drawbacks of neo-adjuvant chemotherapy in patients with operable breast cancers > 3 cm.Material and methodsTwo hundred and seventy-two women (age 70) with operable breast cancers larger than 3 cm (T2-3/N0-1/M0) were included in a randomised trial from January 1,1985 to April 30,1989. Patients in group A (n = 138) were treated by mastectomy and axillary node dissection. Adjuvant chemotherapy was indicated for 104 patients with axillary node involvement (n = 82) or negative oestrogen and progesterone receptors (EPR-) (n = 22). Patients in group B (n = 134) were treated by initial chemotherapy (identical as in group A) followed by locoregional treatment according to the response. Before treatment, the average of clinical tumoural diameter was 43 mm.ResultsThe median follow-up was 124 months. In group B, 49 patients (36.5%) were resistant to chemotherapy; a conservative breast surgical treatment was performed in the other 84 patients sensitive to chemotherapy (62.6%). In this last subgroup, 19 (22.6%) needed a secondary mastectomy because of locoregional recurrence. Survival rates were not different in groups A and B, but loco-regional recurrences were frequent in group B. At 10 years, the overall survival rate was 60% and half of living patients in group B were free of cancer and with their breast.ConclusionNeoadjuvant chemotherapy permitted in twothirds of cases breast conservation treatment, initially considered to be impossible. Locoregional recurrences are more frequent than after mastectomy and adjuvant chemotherapy.     

新辅助治疗对雌激素受体低表达/人类表皮生长因子受体2阳性乳腺癌腋窝淋巴结状态的影响

目的评估人类表皮生长因子受体2（HER2）阳性乳腺癌患者接受不同新辅助治疗（NAC）方案后腋窝淋巴结病理缓解情况及影响因素。 方法纳入2010年11月至2015年12月中山市人民医院收治的100例HER2阳性、Ⅱa~Ⅲc期乳腺癌患者，在NAC前通过触诊和细针穿刺（FNA）评估腋窝淋巴结状态。所有患者接受4~6个周期的PCrb（紫杉醇175 mg/m²和卡铂AUC=6，每3周），部分患者接受联合曲妥珠单抗（6 mg/kg每3周，首剂8 mg/kg）。 结果62例通过FNA确定为腋窝淋巴结阳性（A组），38例通过FNA或触诊确定为腋窝淋巴结阴性（B组）。其中A组总体腋窝淋巴结病理阴性率（pNNR）为53.2％，B组为71.1％。雌激素受体（ER）低表达/HER2阳性患者的pNNR最高，A组为81.0％，B组86.7％。多因素分析显示，联合曲妥珠单抗和ER状态是预测HER2阳性乳腺癌pNNR的独立因素。 结论对于治疗前腋窝淋巴结阳性的乳腺癌患者，如果NAC联合靶向治疗后前哨淋巴结阴性，ER低表达/HER2阳性就不需要腋窝淋巴结清扫。     

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.     

保留乳头乳晕复合体改良根治术的选择和比较

目的 总结乳腺癌根治术中保留乳头乳晕复合体（NAC）的效果与体会。方法 选择2018年3月至2021年3月在我院因乳腺癌进行外科手术治疗的女性患者,纳入标准：①原发性肿瘤位于乳晕外;②肿瘤距离乳晕边缘>2 cm,共有99例患者入组,包括45例实施保留NAC的改良乳癌根治术（NSM）（NAC保留组）和未保留NAC的手术44例（NAC未保留组）。观察NSM后的临床效果,比较NAC保留和未保留患者术后病理特征、并发症,观察术后NAC感觉恢复情况。结果 术前检查：两组患者在年龄、NAC直径、乳头距离肿瘤、术前肿瘤分期、类型、肿瘤部位及多病灶例数间的差异没有统计学意义（P>0.05）。NAC保留组术后病理：35例（77.8%）浸润性癌,10例（22.2%）属于导管原位癌,中位肿瘤大小为2.4 cm（0.2~4.1 cm）,5例发现腋窝淋巴结转移;NAC未保留组中,浸润性癌37例（84.1%）,7例（15.9%）原位癌,中位肿瘤大小为2.6 cm（0.2~4.7）cm,7例腋窝淋巴结转移。两组各有12例发生脂肪液化和血清肿,各有2例切口轻度感染,经保守治疗愈合。NAC保留组有8例乳头或乳晕坏死,其中7例为小部分坏死,经保守治疗愈合,1例坏死面积大行NAC切除。另NAC保留组和未保留组分别有3例和5例皮瓣坏死,均通过保守处理愈合。NAC保留患者中有3例（7.3%）乳晕感觉完全恢复,18例（43.9%）部分恢复,20例无感觉,乳头感觉恢复最差,仅1例患者术后乳头感觉敏感。两组患者术后满意度接近。结论 保留NAC的改良乳癌根治术可行,美容效果良好,但只有较少部分NAC感觉恢复。     

A case report of locally advanced triple negative breast cancer showing pathological complete response to weekly paclitaxel with bevacizumab treatment following disease progression during anthracycline-based neoadjuvant chemotherapy

IntroductionNeoadjuvant chemotherapy (NAC) is the standard of care for locally advanced triple negative breast cancer, however, approximately 5% of cases show disease progression during NAC. Although downstaging is essential to create an opportunity for curative surgery and to improve the local control outcome in such a case, no additional line of chemotherapy has been established.Case presentationA 60-year-old woman was referred to our hospital for an axillary mass presenting three weeks ago and was diagnosed as having right locally advanced (T2N2M0, stage IIIA) triple negative breast cancer. After two courses of epirubicine and cyclophosphamide as NAC, disease progression was recognized and curative resection was considered impossible due to enlarged axillary lymph nodes showing invasion to surrounding tissue. As second-line chemotherapy, weekly paclitaxel with bevacizumab treatment was initiated and significant shrinkage was immediately obtained. A clinically complete response was diagnosed after four courses of weekly paclitaxel with bevacizumab and she underwent a right breast mastectomy with axillary lymph node dissection without major complications. Histopathological examination of surgical specimens showed no residual invasive or noninvasive disease and she was diagnosed as having a pathological complete response.ConclusionsAlthough the addition of bevacizumab to standard adjuvant chemotherapy is not recommended in unselected triple negative breast cancer, the potent effect on tumor shrinkage should be considered in the treatment of locally advanced triple negative breast cancer showing disease progression during standard NAC.     

Management of the axilla following neoadjuvant chemotherapy for breast cancer- A change in practice

ObjectivesChemotherapy in the neo adjuvant setting has allowed downsizing of breast tumours thus allowing patients to benefit from breast conservation surgery. The effect of neoadjuvant chemotherapy (NAC) has also been observed in the axilla but most units are still treating the axilla with axillary lymph node dissection (ALND).Materials and methodsA prospective database of breast cancer patients receiving NAC between 2007 and 2016 at a single breast unit was reviewed. The management of the axilla and outcomes was studied.Results165 patients received NAC, 123 (74.5%) were clinically/radiologically node positive and 42 were negative. Median age was 50 years. 26.7% had triple negative disease and 34.5% were HER2 positive. 56/123 (45.5%) patients with positive nodes at the outset responded completely to NAC. 40 patients with positive nodes pre-NAC had post NAC SLNB with 37 requiring adjuvant radiotherapy only. 83/123 went directly to ALND post NAC and of these 27 were node negative and therefore may be considered to have had an unnecessary ALND. Overall mortality was 20.6% (34), local recurrence in the breast or mastectomy scar was 3.6% (6) but there was no recurrence in the axilla (0/165) with a median follow up of 67 months.ConclusionThere is no clear evidence for management of the axilla post NAC. We have used best available evidence to change our practice over the years and our results should encourage others to de-escalate treatment of the axilla in line with the recently published multidisciplinary guidance on axillary surgery following neoadjuvant chemotherapy.     

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.     

Survival after treatment for breast cancer in a geographically defined population

BACKGROUND: South East Sweden with 976 000 inhabitants is served by nine hospitals with specialized breast surgeons. Population-based mammographic screening was introduced in 1986 for women aged 40-74 years. Patients with primary breast cancer were treated according to a joint management programme. METHODS: All patients were reported to a regional cancer registry from which breast cancer incidence, treatment and survival in this defined population were reported. RESULTS: A total of 7892 women had their first invasive breast cancer diagnosed between 1986 and 1999. The median tumour size was 17 mm and 29.9 per cent had axillary metastases. Some 49.8 per cent of these women had a modified radical mastectomy and 31.9 per cent had a segmental resection with axillary clearance. Postoperative radiotherapy was given to 40.3 per cent of the women after mastectomy and to 87.1 per cent after breast-conserving surgery. Tamoxifen and chemotherapy were used as adjuvant treatment except in low-risk patients. Breast cancer-specific survival rate for all stages was 83.5 per cent at 5 years and 74.0 per cent at 10 years. Respective values were 95.8 and 90.9 per cent for patients with stage T1 N0 M0 tumours, and 77.7 and 62.4 per cent for those with T1-2 N1 M0 tumours. CONCLUSION: Breast specialists treating women with breast cancer according to a joint management programme have achieved very good survival rates.