35岁以下乳腺癌患者保乳术与改良根治术比较及保乳术预后因素观察

目的:比较年轻乳腺癌患者（年龄≤35岁）保乳手术及改良根治术后疗效，并对保乳手术的患者进行预后相关因素分析。方法:回顾性分析1995年1 月至2006年12月天津医科大学附属肿瘤医院收治并分别实施保乳手术（71例）及改良根治术（70例）的年轻乳腺癌患者临床病理资料，比较两组的局部复发及生存情况，并分析年龄、肿瘤大小、淋巴结情况、组织学分级等因素对保乳患者生存情况的影响。结果:所有患者随访时间12～156 个月，中位时间56个月。保乳组:局部复发5 例，远处转移8 例，死亡7 例；3 年无瘤生存率94.4% ，5 年无瘤生存率78.9% ，总生存率90.1% 。改良组:局部复发3 例，远处转移6 例，死亡5 例；3 年无瘤生存率95.7% ，5 年无瘤生存率82.9% ，总生存率92.9% ；且对两组进行比较后均无显著性差异（P 均>0.05）。 对保乳组患者进行预后相关因素分析，切缘阳性与局部控制率、无瘤生存率、总生存率相关（P 均<0.05）；淋巴结转移与无瘤生存率、总生存率相关（P均<0.05）。结论:年轻乳腺癌患者的保乳手术与改良根治手术在局部复发及远期生存等方面无显著性差异，尤其是对于早期年轻乳腺癌患者，保乳手术是安全的，且局部控制尚满意，切缘阳性、淋巴结转移是影响预后的主要因素。 

Comparion between Breast-Conserving Therapy and Modified Radical Mastectomy in Breast Cancer Patients Younger than 35 years and Prognostic Factors of Breast-Conserving Surgery

Objective:To analyze the results of comparion between the breast-conserving therapy (BCT) and modified radical mastectomy (MRM) in the young breast cancer patients (< 35years), and the prognostic factors of BCT in the pa-tients. Methods:The clinicopathologic data of young women with breast cancer who had undergone BCT (71) and MRM (70cases) in our hospital, during a period from January 1995 to December 2006, was retrospectively analyzed. Local re -lapse and survivals of the patients between the two groups were compared, and the influencing factors for survival of the breast-conserving patients, such as the age, tumor size, lymph nodes drainage, histological type and prognosis, were ana-lyzed. Results:All patients were followed-up for a period ranging from12to 156 months, with a median of56. In the breast conservation group, local recurrence occurred in 5 cases, distant metastasis in 8, and death in 7. The 3-year tumor-free sur -vival rate was 94.4%, the 5-year tumor-free survival rate was 78.9%, and the overal survival rate was 90.1%. In the modi-fied surgery group, local relapse occurred in 3 cases, distant metastasis in 6, and death in 5. The 3-year tumor-free survival rate was 95.7%, the 5-year tumor-free survival rate was 82.9%, and the overall survival rate was 92.9%. There were no sta-tistical differences in comparion between the two groups ( P>0.05). Based on an analysis of prognostic correlation factors in patients with breast conserving surgery, the positive incisal margin correlated to the local control, tumor-free survival, and overall survival rates (P<0.05), and the lymph node metastasis correlated to the tumor-free survival and overall survival rates (P<0.05). Conclusion : There are no apparent statistical differences in the comparison of the local relapse and long-term survival rates between the young breast cancer patients of the two groups who respectively underwent the BCT and MRM. The BCT is secure and the local control rate satisfactory in the patients, especially in the young patients with ear-ly-stage breast cancer. while positive marginal status and nodal metastasis are the major prognostic factors of BCT in the young women with breast cancer (≤35years).