摘要
目的新辅助化疗(neoadjuvant chemotherapy,NCT)后未获得病理完全缓解(pathological complete response,pCR)的局部晚期乳腺癌(locally advanced breast cancer,LABC)患者的治疗影响乳腺癌整体预后的提高。本研究评估不同的根治手术对NCT后未获得pCR的Ⅲ期LABC患者的预后影响。方法收集天津医科大学肿瘤医院2011-01-01-2013-12-31收治的186例NCT后未获得pCR的Ⅲ期LABC患者的临床资料,其中120例行改良根治术(modified radical mastectomy,MRM),66例行Halsted根治术(HRM),分析不同的根治手术对3年无局部区域复发生存率(loco-regional recurrence-free survival,LRRFS)和无远处转移生存率(distant metastasis-free survival,DMFS)的影响。结果 Kaplan-Meier分析显示,MRM组和HRM组3年LRRFS分别为86.8%和93.8%,差异无统计学意义,χ~2=2.296,P=0.130;3年DMFS分别为80.0%和87.9%,差异无统计学意义,χ~2=0.774,P=0.379。但对于ⅢB/ⅢC期患者MRM组和HRM组的3年LRRFS分别为80.5%和95.2%,差异有统计学意义,χ~2=4.792,P=0.029;3年DMFS分别为76.2%和85.7%,差异无统计学意义,χ~2=0.298,P=0.585。N3期患者而不是T>5cm患者可以得到相似的结果。单因素分析结果显示,绝经状态(χ~2=4.317,P=0.038),肿瘤大小(χ~2=4.200,P=0.040),淋巴结分期(χ~2=4.635,P=0.031)也与ⅢB/ⅢC期局部晚期乳腺癌患者的3年LRRFS相关。Cox回归分析显示,术式(HR=0.211,P=0.047),淋巴结分期(HR=4.725,P=0.020)为影响ⅢB/ⅢC期局部晚期乳腺癌患者LRRFS的独立预后因子。结论 HRM可以提高ⅢB/ⅢC期局部晚期乳腺癌患者3年LRRFS,降低患者的局部区域复发率,改善局部晚期乳腺癌患者预后。
OBJECTIVE The treatment of LABC patients who didn＇t get pCR from NCT is a tough clinical problem in the world and hampering to improve the overall prognosis of breast cancer patients.The aim of this study was to evaluate the impact of different radical surgery on these patients with stageⅢ disease.METHODS During January 1,2011 to December 31,2013,the clinical data of 186 patients suffering from LABC with stageⅢ disease were collected from Tianjin Medical University Cancer Institute and Hospital,of whom 120 patients received modified radical mastectomy（MRM）and66patients received Halsted radical mastectomy（HRM）,and data of all the patients＇ type of surgery were analyzed.The relationship between these data and 3-year loco-regional recurrence-free survival（LRRFS）,3-year distant metastasis-free survival（DMFS）were studied.RESULTS At Kaplan-Meier analysis,the 3-year LRRFS in MRM group and HRM group was 86.8% and 93.8%,χ~2=2.296,P=0.130;and 3-year DMFS was 80.0% and 87.9%,χ2=0.774,P=0.379.However,for patients with stageⅢB/ⅢC disease,the 3-year LRRFS in MRM group and HRM group was 80.5% and95.2%,χ2=4.792,P=0.029;and 3-year DMFS was 76.2% and 85.7%,χ2=0.298,P=0.585.The same result can be seen in patients with N3 disease but not T5cm disease.Single factor analysis showed that menopausal status（χ2=4.317,P=0.038）,tumor size（χ2=4.200,P=0.040）,lymph node stage（χ2=4.635,P=0.031）were also interrelated to3-year LRRFS of LABC patients with stageⅢB/ⅢC disease.Cox analysis showed that type of surgery（HR=0.211,P=0.047）,lymph node stage（HR=4.725,P=0.020）were independent prognostic factors of LRR risk for LABC patients with stageⅢB/ⅢC disease.CONCLUSION Receiving HRM can enhance the stageⅢB/ⅢC patients＇ 3-year LRRFS,reduce the patients＇ relapse rate and improve prognosis.
出处
《中华肿瘤防治杂志》
CAS
北大核心
2017年第9期621-625,共5页
Chinese Journal of Cancer Prevention and Treatment
关键词
局部晚期乳腺癌
新辅助化疗
改良根治术
HALSTED根治术
无局部区域复发生存率
无远处转移生存率
locally advanced breast cancer
neoadjuvant chemotherapy
modified radical mast-ectomy
Halsted radical mastectomy
locoregional recurrence-free survival
distant metastasis-free survival
