卵巢黏液性腺癌106例临床分析

[目的]探讨与卵巢黏液性腺癌预后可能的相关因素。[方法]回顾性分析中山大学肿瘤防治中心妇科收治的106例卵巢黏液性腺癌病例资料。[结果]106例患者的5年、10年生存率分别为67.0%和59.0%。单因素分析显示,FIGO分期、手术是否能达到满意肿瘤细胞减灭术、合并卵巢腺瘤或交界瘤病史、淋巴结病理、腹水病理是卵巢黏液性腺癌患者预后的影响因素;而多因素分析显示,FIGO分期和是否达到满意肿瘤细胞减灭术是其独立预后因素。[结论]对于卵巢黏液性腺癌,FIGO分期、手术是否能达到满意肿瘤细胞减灭术是影响预后的独立因素。卵巢黏液性腺癌治疗的首要方法是手术治疗。对于早期需保留生育功能的患者,可行保守性手术。对于晚期患者,应尽量达到满意肿瘤细胞减灭术。     

双路径先期化疗对Ⅲ期卵巢癌疗效和预后的影响

目的 探讨双路径先期化疗对Ⅲ期卵巢癌肿瘤细胞减灭术加术后化疗疗效和预后的影响.方法 将36例Ⅲ期卵巢癌分为A、B两组,A组行双路径先期化疗加中间肿瘤细胞减灭术加术后化疗(22例);B组行初次肿瘤细胞减灭术加术后化疗(14例).比较两组肿瘤细胞减灭术的彻底性、病情缓解率和生存率.结果 A、B组达到理想肿瘤细胞减灭术者分别占86.4%和35.7%;手术时间分别为(190±20)min和(270±30)min;术中出血分别为(400±100)ml和(800±200)ml;病情缓解率分别为77.3%和35.7%;1,3年生存率分别为90.9%、64.3%和68.2%、35.7%(P＜0.05),5年生存率分别为31.8%和21.4%(P＞0.05).结论 双路径先期化疗用于Ⅲ期卵巢癌治疗,可以降低肿瘤细胞减灭术风险,提高理想肿瘤细胞减灭术比例和术后化疗反应率,对生存率有益.     

细胞减灭术+腹腔热灌注化疗治疗腹膜假黏液瘤—单中心854例经验总结

目的:腹膜假黏液瘤(pseudomyxoma peritonei,PMP)是一种罕见的临床综合征,细胞减灭术(cytoreductive surgery,CRS)联合腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)因其良好的治疗效果已经成为各中心公认的标准治疗方案,航天中心医院从2008年开始致力于PMP患者诊治工作,2016年开始将全腹膜切除应用于临床,本研究通过对既往资料进行收集整理,对PMP治疗经验进行总结。方法:回顾分析2008年1月到2019年1月航天中心医院腹膜假黏液瘤中心收治并接受手术治疗的PMP患者临床资料及随访结果。对所有患者的手术方式、根治程度及并发症发生情况等临床资料进行搜集整理,并通过随访结果对相关因素进行生存分析,了解CRS+HIPEC在PMP治疗中的临床价值,同时对腹膜切除技术治疗效果进行评价。结果:共纳入854例患者,平均年龄50岁,中位改良腹膜肿瘤指数(peritoneal cancer index,PCI)为29,其中25.5%的患者接受了根治性手术切除,细胞减灭程度(completeness of cytoreduction,CC)达到0或1。总体并发症发生率为21.7%,围术期死亡率为1.1%。自2016年引进腹膜切除技术后,本中心达CC-0/1的比例由14.3%升至36.5%,且并发症发生率显著下降(16.8%vs.28.8%,P<0.001)。总体而言,CC-0/1的患者5年和10年生存率分别为77%、64.3%,显著优于CC-2/3患者的45.8%、39.4%。在未达根治的患者中,CC-2和CC-3患者10年生存率也存在明显差异(45.5%vs.34.5%,P=0.006)。对总体生存进行分析,改良腹膜肿瘤指数、手术方式、术中是否行热灌注治疗、病理级别、CA125水平均为影响术后生存的独立危险因素。结论:细胞减灭术+腹腔热灌注化疗治疗腹膜假黏液瘤安全有效,腹膜切除技术可显著提高根治程度并降低并发症风险;对于无法达到根治切除的患者,最大限度的减瘤亦可延长远期生存。     

肿瘤细胞减灭术联合腹腔热灌注化疗对胃癌腹膜转移患者治疗效果及生活质量影响的研究

摘 要：［目的］ 探讨肿瘤细胞减灭术联合腹腔热灌注化疗对胃癌腹膜转移患者的治疗效果及生活质量的影响。 ［方法］ 对86例胃癌腹膜转移患者的临床资料进行回顾性分析,根据患者所开展的治疗方式的不同分为观察组45例及对照组41例。观察组患者行肿瘤细胞减灭术联合腹腔热灌注化疗,对照组患者行肿瘤细胞减灭术及常规静脉注射全身化疗。对两组患者细胞减灭程度、术后并发症、化疗不良反应、1年生存率以及生活质量进行观察与比较。 ［结果］ 观察组患者肿瘤细胞减灭程度0级患者占80.00%,对照组70.73%,两者差异无统计学意义（P>0.05）。观察组患者术后并发症发生率为17.78%,对照组17.07%,两组相较差异无统计学意义（P>0.05）。观察组患者腹胀、腹泻发生率明显高于对照组,而白细胞减少及血小板减少发生率明显低于对照组,差异均具有统计学意义（P<0.05）。两组患者治疗后生活质量评分比较结果显示,观察组患者躯体功能及总体状况得分明显优于对照组,差异具有统计学意义（P<0.05）。观察组患者1年生存率为64.44%,远高于对照组31.71%,差异具有统计学意义（P<0.05）。［结论］ 肿瘤细胞减灭术联合腹腔热灌注化疗对胃癌腹膜转移患者具有良好的治疗效果及安全性,对于患者生活质量改善及生存率提高有积极意义,值得在排除相关禁忌证的患者中推广应用。     

倾向性评分匹配评估肿瘤细胞减灭术联合腹腔热灌注化疗治疗晚期卵巢癌的疗效

  目的  探讨传统减瘤术与肿瘤细胞减灭术（cytoreductive surgery,CRS）联合术中腹腔热灌注化疗（hyperthermic intraperitone-al chemotherapy,HIPEC）治疗上皮性卵巢癌腹膜转移（peritoneal carcinomatosis of epithelial ovarian cancer,EOCPC）的疗效。  方法  收集2004年5月至2019年5月186例于首都医科大学附属北京世纪坛医院行手术切除的卵巢癌患者的临床病理资料,采用倾向性评分匹配（propensity score matching,PSM）2:1匹配后,纳入133例EOCPC患者,分为行传统减瘤术80例为对照组、行CRS+HIPEC53例为研究组,并行亚组分析。比较两组中位生存期（median overall survival,mOS）。  结果  研究组患者mOS显著长于对照组（87.3个月vs.25.2个月,P=0.002）,5年生存率为对照组2.5倍（46.5% vs.18.3%,P=0.003）,3、4年生存率均为对照组1.9倍（70.0% vs.36.7%,P=0.016）。亚组分析显示,达到满意肿瘤细胞减灭研究组mOS较对照组显著延长（118.1个月vs.70.7个月,P=0.024）;未达到满意肿瘤细胞减灭研究组mOS显著长于对照组（87.3个月vs.23.1个月,P=0.028）。  结论  标准化、规范化CRS+HIPEC为治疗EOCPC的必要措施,可为患者带来显著的生存获益。      

18例原发性腹膜癌诊治分析

目的探讨原发性腹膜癌的临床特点、诊断标准、治疗方法及预后。方法对本院收治的18例原发性腹膜癌的临床资料进行回顾性分析,以腹胀、腹水、食欲差、消瘦为首发症状16例(88.89%)。18例均行肿瘤减灭术,病理为浆液性乳头状腺癌。术后给予铂类为主方案化疗6~8个疗程。结果随访<2年2例,均无瘤生存;>2年16例。总2年、3年、5年生存率分别为75%(12/16)4、3.75%(7/16)2、5%(4/16)。14例Ⅲ期患者2年、3年5、年生存率分别为78.57%(11/14)、50%(7/14)2、8.57%(4/14),Ⅳ期2例,1例生存13个月,1例生存25个月;残存肿瘤<2.0 cm和>2.0 cm,2年生存率各为100%(9/9)和42.86%(3/7),3年生存率各为87.5%(7/9))和0,5年生存率各为44.45%(4/9)和0;腹腔化疗 全身化疗与单纯全身化疗2年生存率各为90%(9/10)和50%(3/6),3年生存率各为70%(7/10)和0,5年生存率各为40%(4/10)和0。结论临床警惕腹胀、腹水患者原发腹膜癌的可能。积极减瘤术和以DDP为主腹腔化疗目前是原发性腹膜癌的最好方法。术前化疗有利于减瘤术。     

晚期卵巢癌术前新辅助化疗的临床研究

目的探讨新辅助化疗对晚期卵巢癌的临床意义。方法①对56例Ⅲc、Ⅳ期上皮性卵巢癌采用新辅助化疗,肿瘤细胞减灭术加以铂类和（或）紫杉醇为主的化疗组（A组）：术前给予1～3个疗程以铂类和（或）紫杉醇为主的化疗,途径为静脉＋腹腔或静脉化疗,每3周1次,56例患者共施行新辅助化疗109次;②49例Ⅲc、Ⅳ期上皮性卵巢癌传统肿瘤细胞减灭术加以铂类和（或）紫杉醇为主的化疗组（B组）;A,B两组均按卵巢癌手术原则行最大限度减瘤术,部分患者进行腹膜后淋巴清扫,术后1周左右开始化疗,均采用联合化疗6～8个疗程,方案和剂量同新辅助化疗。结果A组新辅助化疗总有效率（CR＋PR）为85.7%,胸、腹水控制有效率为93.6%。A组满意肿瘤细胞减灭术（术后残瘤最大直径〈2cm）80.4%,减瘤术（术后残瘤最大直径≥2cm）19.6%;B组满意肿瘤细胞减灭术51.0%,减瘤术49.0%,两组比较有显著性差异（P〈0.01）,A组缩短了手术时间,减少手术出血,为术后化疗创造了有利条件,新辅助化疗毒副反应轻,可以耐受。5年生存率A组为35.7%,B组为15.6%,两组比较有显著性差异（P〈0.05）。结论新辅助化疗有可能为晚期上皮性卵巢癌患者创造手术条件,提高达到满意肿瘤细胞减灭术,改善生存质量,提高生存率。     

新辅助化疗对晚期上皮性卵巢癌患者预后的影响

目的 探讨新辅助化疗对Ⅲc～Ⅳ期上皮性卵巢癌患者预后的影响.方法 回顾性分析160例Ⅲc～Ⅳ期上皮性卵巢癌患者的临床病理资料,其中42例患者行新辅助化疗后再行肿瘤细胞减灭术(NAC组),118例患者先行初次肿瘤细胞减灭术(PCS)再行化疗(PCS组),比较两组患者的生存情况及与预后相关的因素.结果新辅助化疗的总有效率为69.1%.在手术时间、术中出血量和输血量等方面,NAC组与PCS组的差异无统计学意义(P＞0.05).NAC组肿瘤细胞减灭术的满意率为88.1%,明显高于PCS组(71.2%,P＜0.05).NAC组和PCS组的复发率分别为43.2%和56.0%,差异无统计学意义(P＞0.05).NAC组的中位无瘤生存时间和中位疾病无进展生存时间分别为7个月和8个月,低于PCS组的13个月和18个月(P＜0.05);但是NAC组和PCS组的中位总生存时间分别为34个月和43个月,差异无统计学意义(P＞0.05).NAC组有37例患者行满意的肿瘤细胞减灭术(OCS),中位总生存时间为34个月;PCS组有84例患者行OCS,中位总生存时间为48个月,两组差异无统计学意义(P＞0.05).结论 新辅助化疗可以提高Ⅲc-Ⅳ期上皮性卵巢癌患者肿瘤细胞减灭术的满意率,但未降低患者治疗后的复发率,也未延长患者的总生存时间.     

原发性卵巢癌肉瘤4例诊治分析

目的探讨卵巢癌肉瘤的临床病理特点、治疗及预后因素。方法回顾性分析我院近年诊治的4例卵巢癌肉瘤的临床资料,并复习相关文献。结果 4例患者均进行了满意的肿瘤细胞减灭术,术后辅以铂类为基础的联合化疗,随访时间3～12个月,3例无瘤生存,1例带瘤生存。结论卵巢癌肉瘤恶性程度高,预后差,理想的肿瘤细胞减灭术,辅以铂类为基础的化疗,可能提高生存率。     

扩大姑息减瘤对阑尾源性腹膜假性黏液瘤患者远期生存的作用

摘 要：［目的］ 分析扩大姑息减瘤范围对改善腹膜假性黏液瘤(pseudomyxoma peritonei,PMP)患者预后的作用。［方法］ 回顾性分析接受肿瘤细胞减灭手术(cytoreductive surgery,CRS)治疗但仅达到姑息减瘤的阑尾来源PMP患者资料,并应用倾向评分匹配(propensity score-matching,PSM)方法平衡资料中的选择偏倚。［结果］ 共567例未接受达到完全性CRS的患者纳入研究,其中PSM后良好匹配患者153对。匹配后CC-2（残余肿瘤直径为2.5 mm~2.5 cm）患者5年生存率和10年生存率分别为33%和18%,与CC-3（残余肿瘤直径>2.5 cm）患者比较差异无显著性 (5年生存率39%,10年生存率30%;P=0.829)。 以PMP初始诊断日期计算生存期,两者间也无显著性差异(10年生存率 CC-2 vs CC-3：32% vs 44%;P=0.292)。 多因素分析显示,手术时间(OR=2.1,P<0.001),病理类型(OR=1.57,P=0.004)和是否接受腹腔热灌注化疗（hyperthermic intraperitoneal perfusion chemotherapy,HIPEC）(OR=2.01,P=0.002)是影响预后的独立危险因素。［结论］ 对无法彻底清除病灶的PMP患者,扩大切除手术范围并不能延长患者的远期生存,该部分患者实施HIPEC治疗存在生存获益可能。     

Comparative analysis of perioperative intraperitoneal chemotherapy regimen in appendiceal and colorectal peritoneal carcinomatosis

Background

Perioperative intraperitoneal chemotherapy (PIC) is delivered by intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC). The relative survival benefits of each or both regimens are explored in this large series of patients undergoing cytoreduction at a single institution.

Methods

Patients with a complete (CCR0) or optimal (CCR1) cytoreduction who received intraperitoneal chemotherapy for appendiceal and colorectal peritoneal carcinomatosis were included for analysis. PIC regimens were delivered according to the treatment protocol. Standardized statistical analyses were performed.

Results

Of 262 patients, 98 patients (37%) had colorectal peritoneal carcinomatosis, 108 patients (41%) had low-grade pseudomyxoma peritonei and 56 patients (21%) had appendiceal peritoneal carcinomatosis. For pseudomyxoma peritonei, recurrence-free survival (RFS) did not vary with PIC regimen, 5-year survival was 86% in the HIPEC and EPIC group and 64% in the HIPEC or EPIC group (P = 0.070). For appendiceal peritoneal carcinomatosis, RFS and overall survival (OS) did not vary with PIC regimen. For colorectal peritoneal carcinomatosis, the median RFS was 33 months in the HIPEC and EPIC group, 19 months in the HIPEC alone group and 20 months in the EPIC alone group (P = 0.046). OS did not vary with PIC regimen.

Conclusion

From our experience, without compromising the perioperative morbidity and mortality, PIC consisting of HIPEC and EPIC appears to be associated with potential survival benefits of improved OS in pseudomyxoma peritonei and RFS in colorectal peritoneal carcinomatosis.     

<Emphasis Type="Italic">Pseudomyxoma peritonei</Emphasis> secondary to epithelial appendicular neoplasms. Experience in a non-specialised centre

Introduction Pseudomyxoma peritonei is an infrequent entity, defined by collections of gelatinous material in the abdomen and pelvis and mucinous implants on peritoneum, secondary to the rupture of a mucinous lesion, usually of ovarian or appendiceal origin. Materials and methods We present our experience of 11 cases (6 males and 5 females) diagnosed with pseudomyxoma peritonei secondary to epithelial appendicular neoplasms over 27 years. The mean age of the patients was 68 years. Clinical manifestations were abdominal distension (55%), right lower quadrant pain (45%) suggesting acute appendicitis and constitutional syndrome (36%). An abdominal mass was detected at physical examination in 4 patients. CT scan revealed a tumour in right iliac fossa in 4 patients, peritoneal enlargement in 1 and a liquid collection in 1. Preoperative diagnosis was acute abdomen in 5 patients, peritoneal carcinomatosis in 3 and undetermined abdominal mass in 3. Results Surgical findings suggested pseudomyxoma peritonei in 8 patients and peritoneal carcinomatosis in 3. Appendicectomy was performed in 9 patients, and in 3 of them bilateral anexectomy was also performed. One patient underwent ileocaecal resection and another a right hemicolectomy. In all the cases, mucinous material was eliminated as much as possible. Pathology revealed mucinous cystoadenoma in 6 cases, mucinous cystoadenocarcinoma in 3 and epithelial hyperplasia in 2 patients. Median survival was 54 months, with a 5-year survival rate of 40%. The last case we treated was sent to a reference centre for the treatment of pseudomyxoma peritonei. Conclusions There is no consensus on the best treatment for pseudomyxoma peritonei. We recommend avoiding incomplete surgical resections in non-reference centres and submitting patients to a reference centre to undergo adequate treatment.     

原发性胃肠道非霍奇金淋巴瘤的临床特征及疗效分析

背景与目的:原发性胃肠道淋巴瘤是来源于结外淋巴组织的非霍奇金淋巴瘤(non-Hodgkinslymphoma,NHL),具有独特的临床病理特征。本文报告原发性胃肠道淋巴瘤的临床病理特征及其治疗效果。方法:回顾性分析我院1994年1月至2000年6月收治的经病理检查证实的22例原发性胃肠道淋巴瘤患者的病例资料。结果:本研究所有病例均随访3年以上,随访5年以上13例,3、5年生存率分别为45.5%(10/22)、38.5%(5/13);随着临床分期增高,3、5年生存率降低;低度恶性边缘带粘膜相关淋巴组织淋巴瘤较其它病理类型预后为佳;16例治疗后达到完全缓解者,3、5年生存率分别为62.5%(10/16)、45.5%(5/11),而6例原发灶未控者3年生存率为0,有显著性差异(P<0.05);12例单纯手术治疗者3、5年生存率分别为33.3%(4/12)、10%(1/10),6例手术联合化、放疗者(5例手术后辅助化疗,1例手术后行全腹照射)的3、5年生存率分别为83.3%(5/6)、66.7%(2/3)。结论:原发性胃肠道淋巴瘤应以综合治疗为主,原发灶未控可影响预后。     

Analysis of the treatment of pseudomyxoma peritonei--cytoreductive surgery with chemotherapy and intraperitoneal inoculation after washing with dextran

Twelve cases of pseudomyxoma peritonei in the Department of Obstetrics and Gynecology in Kurume University School of Medicine were categorized in three groups by treatment; 3 cases with just operations, 6 cases with chemotherapies after operations and 3 cases with chemotherapies and intraperitoneal inoculations of cisplatin after washing with dextran. These treatments were analyzed by their survival rates. As to the cases repeated operations, the second look laparotomy was estimated as a cytoreductive surgery, including a prior chemotherapy. Ten of 13 chemotherapeutic courses were effective in the 6 cases with second look laparotomies and five of 6 cases were living without tumor. We confirm the treatment of the intraperitoneal inoculation of cisplatin after dextrose washing with the cytoreductive surgery is one of the most effective therapies for pseudomyxoma peritonei.     

Radical hysterectomy versus radiation therapy for stage IB squamous cell cancer of the cervix

Three hundred forty-five patients with Stage IB squamous cell carcinoma of the cervix were treated at the University of Michigan Medical Center from 1970 to 1985. The overall cumulative 5-year survival rate was 89% and the mean age was 44.6 years. In 213 patients undergoing radical hysterectomy the cumulative 5-year survival rate was 92%; 14 patients were explored for radical hysterectomy that was not performed due to high risk features and their survival rate was 50%. Ninety-seven patients underwent radiation therapy as initial treatment and had a 5-year survival rate of 86%. There was no significant difference when radiation therapy was compared with radical hysterectomy (P = 0.098). The survival rates for lesions 3 cm or smaller were 94% for radical hysterectomy and 88% for radiation therapy. When the lesion was larger than 3 cm, the survival rates were 82% with radical surgery and 73% with radiation therapy. Metastatic disease to lymph nodes was present in 26 of the 213 patients undergoing radical hysterectomy. When 1 to 3 nodes were involved 16 of 19 patients survived and when 4 to 10 nodes were involved 3 of 7 patients survived. The addition of radiation therapy did not influence survival. Complications were similar in both treatment groups. Fistulas occurred in 4 of 213 patients undergoing radical hysterectomy and 1 of 111 undergoing radiation. Second surgery for a complication was required in 6 of 213 patients undergoing radical hysterectomy and 7 of 111 undergoing radiation. Survival and complication rates in early stage squamous cell carcinoma of the cervix are equal with either radical surgery or radiation therapy.     

阑尾源性腹膜假黏液瘤单中心诊疗经验

  目的   总结细胞减灭术加腹腔热灌注化疗（cytoreductive surgery & hyperthermic intraperitoneal chemotherapy，CRS+HIPEC）治疗阑尾源性腹膜假黏液瘤（pseudomyxoma peritonei，PMP）的单中心诊疗经验。   方法   回顾性分析2012年1月至2018年12月于航天中心医院收治，病理证实为阑尾源性PMP并经CRS+HIPEC治疗604例患者的临床数据，进行统计学分析。   结果   604例患者经历621次CRS+HIPEC治疗，平均年龄56.7岁，其中女性364例（60.3%），男性240例（39.7%），平均腹膜癌指数（peritoneal cancer index，PCI）为25.7。28.5%（172/604）的患者完全减瘤（CCR 0/1）。3~4级不良事件发生率为21.7%（131/604），围手术期死亡率为0.7%（4/604），术后5年生存率为53.6%。高级别病理类型、不完全减瘤（CCR 2/3）、PCI>20、3~4级不良事件是PMP患者预后不良的独立危险因素。   结论   阑尾源性PMP临床罕见，治疗方法特殊，对于怀疑或确诊PMP的患者，尽早行规范CRS+HIPEC治疗，有望取得良好的预后。      

121例局限期食管小细胞癌治疗模式探讨

目的 探讨原发性局限期食管小细胞癌综合治疗模式及预后。方法 回顾分析2004—2012年间收治的局限期食管小细胞癌患者121例资料,其中手术组患者98例(单纯手术37例、手术+化疗40例、手术+放化疗21例),非手术组患者23例(放化疗18例、单纯化疗5例)。采用Kaplan-Meier法OS分析并Logrank检验和Cox模型多因素预后分析。结果 手术组1、3年OS率分别为88%、37%,非手术组分别为78%、43%(P=0.585)。手术组内不同治疗模式LC率相近(P=0.113),手术+化疗、手术+放化疗组OS率均优于单纯手术组(P=0.002、0.028)。手术+化疗组1、3年OS率分别为88%、44%,与放化疗组的83%、50%相近(P=0.969)。化疗≥4周期组1、3年OS率分别为89%、53%,高于<4周期组的85%、35%(P=0.036)。多因素分析显示只有化疗与否是影响因素(P=0.006)。结论 局限期食管小细胞癌单纯手术治疗预后差。在系统性化疗基础上的手术治疗比放疗并不能明显提高患者LC和预后。化疗是独立影响因素,推荐化疗周期数至少≥4周期。     

New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome?

Appendiceal mucinous neoplasms sometimes present with peritoneal dissemination, which was previously a lethal condition with a median survival of about 3 years. Traditionally, surgical treatment consisted of debulking that was repeated until no further benefit could be achieved; systemic chemotherapy was sometimes used as a palliative option. Now, visible disease tends to be removed through visceral resections and peritonectomy. To avoid entrapment of tumour cells at operative sites and to destroy small residual mucinous tumour nodules, cytoreductive surgery is combined with intraperitoneal chemotherapy with mitomycin at 42 degrees C. Fluorouracil is then given postoperatively for 5 days. If the mucinous neoplasm is minimally invasive and cytoreduction complete, these treatments result in a 20-year survival of 70%. In the absence of a phase III study, this new combined treatment should be regarded as the standard of care for epithelial appendiceal neoplasms and pseudomyxoma peritonei syndrome.     

转移性三阴乳腺癌的临床特征和治疗结果

目的 分析转移性三阴乳腺癌的临床病理特征、生存情况和局部治疗在转移性三阴乳腺癌中的作用。方法 回顾分析1998—2013年间收治的 220例转移性三阴乳腺癌患者的临床特征和治疗结果。全组 206例初诊Ⅰ~Ⅲ期患者治疗后出现远处转移(186例接受改良根治术、14例保乳手术+放疗、5例单纯保乳术、1例未接受手术;化疗 196例,88例改良根治术后局部区域放疗),14例Ⅳ期初诊时即有远处转移(8例接受改良根治术、1例区段切除术、5例未接受手术)。用Kaplan-Meier法计算生存率,Logrank法检验和单因素预后分析转移后治疗对生存的影响。结果 最常见转移部位为肺和骨,实质性脏器转移182例(82.7%),单器官转移 63例(28.6%),多器官转移 153例(69.5%),4例不详。三阴乳腺癌初诊 3年内转移达高峰,5年后很少发生转移(6.4%)。中位随访时间22个月,全组转移后 5年OS为25.0%,中位生存时间21个月。单器官转移、多器官转移的 5年OS分别为38.2%、17.5%(P=0.005)。合并内脏转移、局限骨转移的 5年OS分别为20.3%、56.2%(P=0.049)。62例单器官转移病例中接受手术或放疗局部治疗组和无局部治疗组的转以后 5年OS分别为48%和29%(P=0.006)。结论 转移性三阴乳腺癌常见内脏实质器官转移,单器官转移预后好于多器官转移;对于单一器官转移,挽救性局部治疗能改善生存;局限于骨转移好于合并内脏转移预后。