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目的探讨对临床Ⅰ、Ⅱ期乳腺癌患者选择性行乳腺癌保留乳房治疗(BCT)的远期生存、同侧乳房复发(IBR)、美容效果及其相关因素。方法1985年10月至2007年12月共对680例临床Ⅰ、Ⅱ期乳腺癌开展BCT临床研究。乳腺癌保乳手术先后采用乳腺象限/区段切除术及肿瘤扩大切除术,联合全腋淋巴结清扫术或前哨淋巴结活检术。术后放疗先后采用Co60及加速器全乳放疗及瘤床缩野照射。结果中位随访10年,680例BCT患者10年总生存率IBR83.7%、同侧乳房复发为8.5%、远处转移率为23.7%。患者年龄、肿瘤大小、病理组织学类型、腋淋巴结转移状况等临床病理因素对BCT后IBR差异无统计学意义(均P>0.05);切缘阳性、术后未行全乳照射的患者IBR显著升高(均P=0.000)。在确保切缘阴性的前提下,不同切除范围的手术方式对IBR差异无统计学意义(P=0.799),但切除范围较大的区段/象限切除术对BCT后乳房美容效果差异有统计学意义(优秀组P=0.043,优秀+良好组P=0.005)。结论临床Ⅰ、Ⅱ期乳腺癌选择性行BCT有较好的远期疗效、较好的美容效果和较低的IBR,可以安全地替代乳房切除性手术;确保切缘阴性及接受术后全乳放疗仍是现阶段乳腺癌BCT的金标准;在确保切缘阴性的前提下,切除范围较小的肿瘤扩大切除术有较好的美容效果和相同的治疗效果。
Objective To investigate the long-term survival, ipsilateral breast recurrence (IBR), cosmetic effects and related factors in breast cancer patients with stage Ⅰ and Ⅱ breast cancer who underwent breast conservative treatment (BCT). Methods From October 1985 to December 2007 a total of 680 cases of clinical stage Ⅰ, Ⅱ breast cancer BCT clinical study. Breast conserving surgery has adopted breast quadrant / segmentectomy and tumor expansion resection, joint axillary lymph node dissection or sentinel lymph node biopsy. Postoperative radiotherapy has used Co60 and accelerator whole milk radiotherapy and tumor shrinking field irradiation. Results The median follow-up of 10 years, 680 BCT patients with 10-year overall survival rate of 83.7% IBR, ipsilateral breast recurrence was 8.5%, distant metastasis rate was 23.7%. There were no significant differences in IBR between clinicopathological factors such as age, tumor size, histopathological type and axillary lymph node metastasis (all P> 0.05); patients with positive margins and postoperative whole milk irradiation had significantly higher IBR (All P = 0.000). There was no significant difference in IBR between surgical approaches with different resection margins (P = 0.799), but with segmentectomy / quadrant resection with large resection range had statistical differences in breast cosmetic results after BCT Significance (excellent group P = 0.043, excellent + good group P = 0.005). Conclusions The selective BCT in stage Ⅰ and Ⅱ breast cancer patients has better long-term curative effect, better cosmetic results and lower IBR, which can safely replace mastectomy; ensure the negative margins and accept postoperative whole milk Radiotherapy is still the gold standard for BCT in breast cancer at the present stage. On the premise of ensuring negative margins, resection of tumors with smaller resection has better cosmetic results and the same therapeutic effect.