乳腺癌保乳手术安全范围的研究

目的:探讨适合中国女性保乳手术的安全切除范围.方法:对48例切缘阴性象限切除标本大切片观察乳腺内原发癌及癌旁病变累犯范围;并对62例全乳腺切除标本采用免疫组化及分子生物学方法,检测癌和癌旁组织PCNA、p53、C-erbB-2等表达情况,分析癌瘤向周边浸润及周围组织癌变趋向的规律.结果:随距原发癌越远,癌旁发生高危病变、PCNA、C-erbB-2及p53阳性的比例逐渐降低(P＜0.05);近乳头端和肿瘤两侧癌旁危险因素阳性病变较远侧端范围广泛(P＜0.05);癌旁不同范围危险因素比例与乳腺原发癌伴有广泛的导管内癌成分(EIC)、C-erbB-2及p53阳性有关(P＜0.05);原发癌组织学Ⅰ级者癌旁未见危险因素存在.结论:保乳术后复发危险因素绝大多数(95.2%)在瘤缘外2cm以内存在,因此推荐以癌旁2cm作为保乳手术的安全切除范围,远离乳头端可缩小手术范围至癌旁1cm处;同时对原发癌EIC( )、C-erbB-2和/或p53阳性表达者应扩大切除范围,达到切缘阴性,降低局部复发率.

Study on safe extension of breast conservative surgery in breast cancer

Objective: To explore the excision extension for breast conservative surgery which is suitable for Chinese women. Methods: 48 cases of negative margin specimen of BCS and 62 specimen of mastectomy were examined using whole specimen section, immunohistochemistry and molecular biology methods to observe pathological changes and expressions of PCNA, P53 and C-erbB-2 in primary tumor and paracarcinoma tissues. Result:s Along with the further distance from primary tumor, the proportions of high risk disease and positive expressions of PCNA, C-erbB-2 and P53 in paracarcinoma tissue were decreased gradually(P<0.05). Disease extension in paracarcinoma tissue was related to extensive intraductal component and positive expressions of C-erbB-2 and P53(P<0.05). Conclusion: Risk factors of local recurrence after BCS were mainly(95.2%) existed within 2cm nearby primary tumor in clinical stage I and II breast cancer. It is recommended that 2cm nearby primary tumor is safe extension for BCS,and it is necessary to choice individual treatment for breast cancer with different clinicopathologic characteristics.