Oncol2012: 隐匿性乳腺癌的治疗及预后分析

目的： 比较隐匿性乳腺癌不同治疗方法的预后结果，并深入探讨可能提示预后和复发的潜在因素。 方法： 我们回顾性分析了1968至2011年于我院治疗的77例隐匿性乳腺癌患者的资料。这些患者被分为3组：接受乳腺切除术及腋窝淋巴结清扫组，接受腋窝淋巴结清扫及术后放疗组以及仅接受腋窝淋巴结清扫组。我们通过生存分析来比较不同治疗方法对隐匿性乳腺癌的疗效。 结果： 在77例隐匿性乳腺癌患者中有2例患者失访，8名患者拒绝行手术治疗，因此共有67例患者纳入本研究。中位随访时间为62.2（0.6-328.0）月。患者被分为三组：全切 腋窝清扫组，腋窝清扫 放疗组和单纯腋窝清扫组。生存分析提示这三组间的总生存率及无复发率无显著差异（总生存率：p=0.494；无复发率：p=0.397）。全切 腋窝清扫组局部复发率为11.9%，腋窝清扫 放疗组为18.8%，单纯腋窝清扫组为11.1%。而三组的远处复发率分别为2.4%，12.5%和11.1%。Wilcoxon分析提示三组间在总生存率和无复发率无显著差异。与PR阴性患者相比，PR阳性患者的生存时间更长，而术后复发率也更低（ (总生存率: p=0.057; 无复发率: p=0.062).结论： 对于隐匿性乳腺癌，改良根治术与保乳手术对于患者的预后并无显著差异。PR的表达情况可能与隐匿性乳腺癌的预后相关。

Treatment outcomes of occult breast carcinoma and prognostic analysis

Purpose: To compare the outcomes of different treatments of occult breast cancer and further evaluate the potential prognostic factors for overall survival and recurrence. Methods We retrospectively reviewed 77 patients presenting to our hospital from 1968 to 2011 with a diagnosis of occult breast cancer. The patients were divided into three groups: 42 patients (63%) treated with modified radical mastectomy axillary lymph nodes dissection (ALND), 16 patients (24%) treated with ALND combined with postoperative radiotherapy and 9 patients (13%) with only ALND. Survival analysis was performed to compare the efficacy of the above three different treatment options. Results Of the 77 patients with occult breast cancers, 2 patients were lost during follow-up and 8 patients refused to surgical treatment, thus a total of 67 patients (90.4%) were included in this analysis. The median follow-up was 62.2 months (0.6-328.0). The cases were classified into three groups: mastectomy ALND, ALND RT and ALND only. The Kaplan-Meier analysis showed no significant difference in the overall survival and recurrence-free survival rates between the three groups (overall survival: p=0.494; recurrence-free survival: p=0.397 ). The local recurrence rates were 11.9% for mastectomy ALND, 18.8% for ALND RT and 11.1% for ALND only and the distant recurrence rates were 2.4%, 12.5% and 11.1%, respectively. However Wilcoxon analysis showed no significant difference in OS or RFS between different treatment groups. Comparing with the PR (-), the PR ( ) patients achieved better survival outcomes and less recurrence rate (OS: p=0.057; RFS: p=0.062). Conclusion There is no significant difference of the outcomes between mastectomy and breast preserving surgery. PR expression level should be taken into account when discussing the prognosis of the occult breast cancer.