新辅助化疗在局部进展期乳腺癌保乳治疗中的临床价值*

目的:探讨局部进展期乳腺癌在新辅助化疗后保乳治疗的可行性。方法:选取1996年1 月~2006年12月经病理组织学检查确诊的局部进展期乳腺癌522 例，随机分为新辅助化疗组和对照组。新辅助化疗组给予FEC 或TEC 方案化疗4~6 个周期后进行影像学再评估，满足保乳条件者实施保乳手术，不满足保乳条件者实施全乳房切除术；对照组均实施全乳房切除术。分析新辅助化疗的有效率及其对局部进展期乳腺癌手术方式以及保乳手术后的局部复发率、远处转移率、总生存率、无瘤生存率及美容效果等的影响。结果:新辅助化疗组总有效率89.19%（231/259），经影像学再评估82.20%（217/264）的患者达到保乳条件，实际实施保乳手术85例，保乳治疗者乳房外观满意率92.94% 。经67.4 个月（36～166 个月）的随访，其局部复发率、远处转移率、总生存率及无瘤生存率分别为7.06%（6/85）、10.59%（9/85）、85.88%（73/85）、78.82%（67/85），与新辅助化疗后满足保乳条件行全乳房切除术的患者及对照组患者比较差异无统计学意义。结论:局部进展期乳腺癌在新辅助化疗后实施保乳治疗是可行的，影像学和病理学检查是选择恰当术式的必要依据。 

Breast-conserving Therapy for Locally Advanced Breast Cancer after Neoadjuvant Chemotherapy

Objective:To investigate the feasibility of breast-conserving therapy (BCT) for locally advanced breast can -cer (LABC) after neoadjuvant chemotherapy (NAC). Methods:A total of522 patients with locally advanced breast cancer were collected between January1996and December 2006and were randomly assigned into the neoadjuvant chemothera -py group (T group) and the control group (C group). Breast-conserving surgery and total mastectomy (MT) were electively performed for T group depending on the imaging and pathology after 4-6 cycles of neoadjuvant chemotherapy consisting of FEC ( 5-Fluorouracil, Epirubicin, Cyclophosphamide) or TEC (Docetaxel, Epirubicin, Cyclophosphamide), whereas total mastectomy was performed for C group. The response rate of the neoadjuvant chemotherapy and its effect on the surgery modality for locally advanced breast cancer was analyzed, and the local recurrence rate, metastatic rate, overall survival rate, disease-free survival rate, and cosmetic results of patients treated with breast-conserving therapy were also studied compared with those who underwent total mastectomy in T group and C group. Results: In T group, the response rate was 89.19% (231 /259 ), and 82.20% (217 /264 ) patients became eligible for breast-conserving therapy by imaging reevaluation after neoadjuvant chemotherapy. Eighty-five patients underwent breast conserving surgery, and the rate of satisfactory cos-metic results was 92.94%. Follow-up for36~166 months (median,67.4 months) showed no statistical? significance in recur-rence rate, metastatic rate, overall survival rate and disease-free survival rate among patients treated with BCT in T group, patients treated with MT in T group, and those in C group. Conclusion:Breast-conserving therapy offers satisfactory effects on patients with locally advanced breast cancer previously treated with neoadjuvant chemotherapy. Imaging and pathologi-cal examination are crucial for selection of appropriate surgical treatment.