早期乳腺癌患者保乳术联合术后放疗与乳房全切术的疗效对比

目的:探讨早期乳腺癌患者保乳术联合术后放疗与乳房全切术的远期疗效。方法:回顾性分析126例保乳手术联合术后放疗与144例乳房全切术治疗早期乳腺癌患者临床病理资料及随访结果，对比两组患者的5年总生存率（overall survival,OS）、无病生存率（disease-free survival，DFS），采用单因素及多因素Cox回归分析两组患者临床病理资料对局部区域复发（local regional recurrence,LRR）及总生存的影响因素。结果:所有患者中位随访时间(84.890±20.474)个月,两组患者临床病理资料差异均无统计学意义（P>0.05）。保乳组:5年总生存率97.6%，5年无病生存率96.8%;乳房全切术组:5年总生存率97.2%，5年无病生存率97.2%，两组5年总生存率、无病生存率均无差异（P>0.05）。Cox多因素回归分析显示，HER-2过表达与局部区域复发率［HR:3.036(95%CI:1.084~8.504)］及总生存率［HR:3.767(95%CI:1.115~12.727)］均相关。结论:早期乳腺癌患者保乳术联合放疗与乳房全切术在5年总生存率、无病生存率方面无显著差异（P均>0.05）。HER-2过表达是影响早期乳腺癌局部区域复发率及总生存率的独立危险因素。在未来的治疗过程中，更倾向于选择保乳术联合术后放疗对早期乳腺癌患者进行治疗。

Comparison of breast-conserving surgery followed by radiotherapy and total mastectomy in patients with early-stage breast cancer

Objective:To discuss the curative effect between breast-conserving surgery followed by radiotherapy (BCS+RT) and total mastectomy (TM) in patients with early-stage breast cancer.Methods:The clinicopathological data of 270 early-stage breast cancer cases were subdivided into BCS+RT (n=126) and TM (n=144) groups.The 5-year overall survival (OS) rate and disease-free survival (DFS) rate between the two group patients were compared,and the influencing factors for local regional recurrence (LRR) and overall survival of the two group patients were analyzed.Results:All patients were followed up with (84.890±20.474) months.In the BCS+RT group,the 5-year OS rate was 97.6%,and the 5-year DFS rate was 96.8%.In the TM group,the 5-year OS rate was 97.2%,and the 5-year DFS rate was 97.2%.There were no statistical differences in comparison of the 5-year OS and DFS rate between two groups (P>0.05).The multivariate Cox analysis showed that in early breast cancer patients with over-expressed HER-2,the hazard ratios of LRR and OS were 3.036(95%CI:1.084~8.504) and 3.767(95%CI:1.115~12.727),respectively.Conclusion:There are no apparent statistical differences in the comparison of the 5-year OS and DFS rate between two groups underwent BCS+RT and TM.Over-expressed HER-2 is an independent influencing factor influencing both the LRR and OS.In the future treatment process,breast-conserving surgery followed by radiotherapy is preferred.