乳腺癌术后复发24例临床分析

目的：探讨乳腺癌术后复发的影响因素。方法：回顾性分析2000年-2010年诊治的248例乳腺癌,其中包括24例复发患者的临床资料。结果：原发肿瘤〈5cm和≥5cm的患者复发率分别为6.45%、31.57%;患者腋窝淋巴结转移阴性和阳性的复发率分别为3.77%、16.94%;激素受体阳性和阴性的复发率分别为10.52%、11.76%;规范化疗和未行化疗患者复发率分别为8.82%、50.0%;行规范内分泌治疗和未行内分泌治疗患者复发率分别为6.14%、17.10%,行规范放疗和未行放疗患者复发率分别为2.43%、71.42%。结论：乳腺癌复发与肿瘤大小,淋巴结有无转移以及术后是否规范化疗、放疗和内分泌治疗有显著相关性,而与激素受体情况无显著相关性。     

影响中国华北地区女性乳腺癌无病生存期的临床病理因素——多中心回顾性研究

摘 要：［目的］ 探讨华北地区乳腺癌术后复发不同时间间隔与临床病理特征的相关性。［方法］ 对华北地区3家医院2012年1月1日至2014年12月31日收治的术后复发转移的乳腺癌病例资料进行分析,分析影响近期复发和远期复发患者的临床病理特征、复发转移规律和特点。［结果］ 696例乳腺癌术后复发患者纳入研究,平均年龄为45.28岁,其中394例患者3年内发生复发转移（56.6%）,3年以上复发转移患者共302例（43.4%）。本研究发现近期复发患者（DFS<36个月）具有初诊年龄低、淋巴结转移≥4个、肿瘤直径>2cm、雌孕激素受体阴性、HER-2阳性、辅助化疗和辅助内分泌治疗的特点;多因素分析显示,淋巴结转移数、术后辅助化疗及内分泌治疗是复发转移间隔时间的独立影响因素。［结论］ 淋巴结转移数≥4个、雌激素、孕激素受体阴性、HER-2表达阳性、术后未进行辅助化疗、内分泌治疗是乳腺癌术后发生早期复发的危险因素,应进行密切随访。     

同期腋窝转移淋巴结受体检测在激素受体阴性乳腺癌中的临床意义

  目的   探讨同期腋淋巴结转移病灶雌激素受体（estrogen receptor,ER）和孕激素受体（progesterone receptor,PR）补测在激素受体阴性浸润性乳腺癌中的临床意义。   方法   观察2012年7月至2013年1月,重庆医科大学附属第一医院内分泌乳腺外科门诊随访及住院患者中补测激素受体阴性乳腺癌同期腋淋巴结转移病灶ER和PR的表达情况,所有标本（包括原发癌病灶及同期腋淋巴结转移病灶）的免疫组织化学检测均由重庆医科大学病理检测中心进行,根据检测报告,原发病灶阴性而腋淋巴结转移病灶ER和/或PR阳性者补加内分泌治疗。   结果   56例激素受体阴性乳腺癌中,同期腋淋巴结转移病灶ER阳性8例（14.3%）,PR阳性2例（3.6 %）,ER和PR均阳性3例（5.4%）,共13例（23.3%）因补查腋淋巴结转移病灶ER和/或PR变阳性而在随访中加用内分泌治疗。肿瘤原发病灶与腋转移淋巴结ER和PR均阴性43例（76.7%）,即肿瘤原发癌病灶与腋转移淋巴结ER和PR均为阴性表达的总符合率为76.7%,不一致率为23.3%。   结论   受体阴性浸润性乳腺癌原发病灶与腋淋巴结转移病灶ER和PR表达具有一定的不一致性,对原发癌病灶激素受体阴性乳腺癌患者应检查其同期腋淋巴结转移病灶受体的表达,可能筛查出原发病灶受体阴性而复发转移病灶受体阳性患者,及时加用内分泌治疗,提高该类患者的疗效,亦可解释部分激素受体阴性而内分泌治疗也有一定疗效的原因。      

男性乳腺癌40例临床分析

目的探讨男性乳腺癌的发病特点、治疗方法和影响预后的因素。方法回顾性总结40例男性乳腺癌的临床特点及治疗方法。结果男性乳腺癌发病年龄偏晚,病程长,最常见的症状是无痛性的乳晕下肿块,确诊时腋淋巴结转移率为57.5%。ER(+)占85.7%,PR(+)占71.4%。术后辅以内分泌治疗、放疗和(或)化疗的患者5年生存率分别为70.6%和65.0%,与未行辅助治疗者5年生存率(22.0%)比较,差异有显著性。腋淋巴结阳性和阴性的患者5年生存率分别为43.5%和73.3%,二者比较差异亦有显著性。结论男性乳腺癌易发生腋淋巴结转移,预后差;且较女性患者的激素受体水平表达高。治疗上首选手术治疗,辅以内分泌治疗、放疗和(或)化疗能明显提高患者的生存率。腋淋巴结转移和术后积极的辅助治疗是影响预后的主要因素。     

乳腺癌术后局部复发因素的探讨

目的探讨乳腺癌术后局部复发的影响因素,以便更有效地预防乳腺癌术后局部复发.方法对1994年1月至2002年12月我院乳腺科女性原发乳腺癌522例患者进行分析,观察年龄、手术方式、肿瘤临床分期、病理组织学类型、腋窝淋巴结转移数目、辅助化疗情况、雌激素受体水平等因素对术后局部复发的影响.结果 522例患者中,局部复发38例,复发率7.3%.其中年龄、手术方式对局部复发无显著影响;临床分期、病理组织学类型、腋窝淋巴结转移数目、化疗完成情况是影响术后局部复发的重要因素.雌激素受体测定双阳性或双阴性对局部复发有直接影响.结论早期诊断是防止乳腺癌复发转移的有效途径.原发肿瘤大小、病理组织学类型、腋淋巴结阳性数是影响局部复发的主要因素.严格掌握保乳手术指征,是减少复发的关键.规范化疗是防止局部复发的重要因素.雌孕激素受体水平是估测局部复发的参考指标.内分泌治疗,可减少局部复发.早期诊断、规范治疗是防止乳腺癌局部复发和转移的有效措施.     

乳腺癌保留乳房治疗局部复发风险因素回顾性分析

目的:探讨早期乳腺癌保留乳房术后局部复发的临床病理危险因素。方法:收集我院1998-09-01-2011-07-31收治的临床0～Ⅱ期行保留乳房手术的146例早期乳腺癌患者的病例资料,采用Cox检验对患者年龄、肿瘤大小、淋巴结状态、雌激素受体(ER)表达、孕激素受体(PR)表达、人类表皮生长因子受体2(HER-2)表达和分子分型与术后局部复发的相关性进行单因素和多因素分析。结果:中位随访61个月,9例患者首发出现患侧乳房局部复发,生存分析显示3年和5年累积局部复发率分别为6.3%和7.5%。患者年龄、肿瘤大小、ER/PR表达状态和分子分型与术后局部复发无明显相关性,P>0.05。HER-2阳性(P=0.002 1)和淋巴结阳性(P=0.03)与局部复发有相关性,且是独立影响因素。结论:HER-2阳性和淋巴结阳性是乳腺癌保留乳房术后局部复发的独立预后高危因素,而患者年龄、肿瘤大小、激素受体表达状态和局部复发无显著相关性。     

乳腺癌术后局部复发原因及其治疗

乳腺癌局部复发多发生于术后2年内.原发肿瘤越大、腋淋巴结转移数越多复发率越高;激素受体阴性、脉管癌栓或分期晚者,复发率高且复发时间缩短;术式不同复发率无显著性差异,术后辅助放疗可明显降低复发率,积极再治疗能改善生存质量,延长生存期,并减少远处转移的发生.     

前哨淋巴结活检术在早期乳腺癌保乳术中的应用

目的探讨前哨淋巴结活检术（sentinellymph node biopsy,SLNB）在早期乳腺癌保乳术中的应用效果。方法回顾性分析56例pT1.2N0M0期乳腺癌行保乳术＋前哨淋巴结活检术的临床资料。56例SLN阴性,未行腋窝淋巴结清扫术（axillary lymph node dissection,ALND）。术后辅以化疗、放疗,激素受体阳性患者行内分泌治疗。结果56例成功施行保乳手术,保乳术后双乳对称。SLNB替代ALND者各项术后并发症少。中位随访时间36个月（1～72个月）,1例发现局部复发,行乳腺癌改良根治术时发现腋窝淋巴结转移;1例发现腋窝淋巴结复发转移。结论SLNB可以缩小手术范围,减少术后并发症,保留腋窝形态,提高保乳质量。     

118例小肿块多腋窝淋巴结转移乳腺癌患者的临床特征和预后分析

目的分析小肿块多腋窝淋巴结转移(肿块直径≤2 cm、腋窝淋巴结转移≥4个)乳腺癌患者的临床特征和预后。方法1993年1月至2003年12月我院共收治小肿块多腋窝淋巴结转移乳腺癌患者118例,对其临床病理特征、辅助治疗进行分析,以发现相关的预后因素。结果全组患者的5年总生存率为75.0%。腋窝淋巴结转移4～9个及≥10个者的5年生存率分别为89.5%和59.8%(P=0.009),术后化疗患者与未化疗患者的5年生存率分别为82.1%和53.3%(P=0.001),术后内分泌治疗者与未行内分泌治疗者的5年生存率分别为89.2%和61.9%(P=0.001)。单因素Kaplan-Merier生存分析显示,肿瘤分期、术后化疗和内分泌治疗是影响患者预后的重要因素。Cox多因素预后分析显示,肿瘤分期、术后化疗和内分泌治疗是影响患者预后的独立因素。结论小肿块多腋窝淋巴结转移的乳腺癌患者具有易于转移的趋势,患者预后较差,尤其是腋窝淋巴结转移≥10个的患者;肿瘤分期、辅助化疗和内分泌治疗是影响患者预后的独立因素;合理的综合治疗有可能改善小肿块多腋窝淋巴结转移乳腺癌患者的预后。     

763例三阴性乳腺癌临床病理特征及复发、转移影响因素分析

目的 通过对三阴性乳腺癌(Triple-negative breast cancer,TNBC)临床病理特征的分析,探讨影响三阴性乳腺癌患者的复发、转移因素和转移淋巴结与原发灶位置之间关系。方法 收集哈医大附属肿瘤医院2008年12月—2012年12月资料完整的763例三阴性乳腺癌患者的临床资料进行回顾性分析。结果 三阴性乳腺癌平均发病年龄49岁,早期患者占84.7%,淋巴结阳性患者复发、转移率均明显高于淋巴结阴性患者,并随淋巴结数目的增多而增加(P＜0.001),对于淋巴结阴性患者,原发灶位于内象限时复发、转移率最高(9.8%和13.7%)(P＜0.05)。单因素分析显示淋巴结状态、手术方式、放疗剂量是影响三阴性乳腺癌患者复发、转移的因素(P＜0.05)。多因素分析显示临床分期、淋巴结状态是影响三阴性乳腺癌复发的独立危险因素,临床分期和和手术方式是影响三阴性乳腺癌转移的独立危险因素(P＜0.05)。结论 (1)三阴性乳腺癌患者早期病例所占比例高,主要病理类型为浸润性导管癌,ki67阳性表达率高;(2)淋巴结阳性患者预后与转移淋巴结数目相关,和原发灶位置无关,对于淋巴结阴性患者,原发灶位于内象限复发、转移率最高;(3)TNBC患者复发率随BMI值的增加而增加,但对于肥胖患者,复发率反而下降;(4)淋巴结状态、临床分期、手术方式、放疗剂量均影响三阴性乳腺癌患者的复发、转移;(5)临床分期、淋巴结状态是影响三阴性乳腺癌复发的独立危险因素,临床分期和和手术方式是影响三阴性乳腺癌转移的独立危险因素。     

Radiotherapy following mastectomy: indication and contraindication of chest wall irradiation

Purpose: To determine in which cases radiotherapy of the chest wall following mastectomy is indicated, based on the local recurrent rate in patients with locally advanced breast cancer.

Methods and Materials: From 1984 until 1994, 105 patients who had four or more histopathologically confirmed axillary nodes metastases, or T3-4Nany, were subjected to mastectomy and were administered radiotherapy postoperatively using the hockey-stick field, which included the ipsilateral supraclavicular fossa and internal mammary nodes, except the chest wall. Median age was 51 years old (range, 23 to 82 years old). Eighty-five patients underwent radical mastectomy, 18 modified radical mastectomy, and 2 extended radical mastectomy. Fraction size was 2 Gy/day, the weekly fraction size was 10 Gy and the total dose ranged from 44 Gy to 54 Gy (median 50 Gy). Seventy-four patients were administered adjuvant chemotherapy, and 61 patients were administered hormone therapy.

Results: The 5-year disease-free survival rates of the whole study population were 66%. The 5-year chest wall recurrence rates were 10%. The 5-year chest wall recurrence rates of the patients who had no vascular invasion (n = 19) and the patients who had definite vascular invasion (n = 38) were 0% and 24%, respectively (p = 0.036). All the patients who presented chest wall recurrence had four or more axillary nodes metastases. Nine of the 10 patients who presented chest wall recurrence had definite vascular invasion, while there was no information about vascular invasion for the remaining patient. Factors such as age, pathological subtypes, tumor location, estrogen receptors, extent of resection, chemotherapy, and hormone therapy did not influence the development of chest wall recurrence.

Conclusion: Among patients with breast cancer who have four or more positive axillary nodes or T3-4Nany, those who have no vascular invasion or less than 4 axillary nodes metastases do not need to be subjected to chest wall irradiation after radical mastectomy.     

Surgical treatment of carcinoma of the breast. V. Changes in patient population and therapeutic modalities at a metropolitan hospital (1971-1980)

This is a retrospective study of 408 patients who had mastectomy for carcinoma of the breast during 1971-1980. Over these 10 years, we have had a significant increase in Hispanic patients. Although the mean size of breast tumors among the Hispanic patients was smaller than that of our black patients, Hispanic patients are more likely to have higher numbers of positive axillary lymph nodes. Similar to the nationwide trend, over 90% of the patients had modified radical mastectomy in recent years, and adjuvant systemic chemotherapy has replaced postoperative radiotherapy for patients with axillary metastasis. Postmastectomy actuarial 5-year relapse rates of our patients with none or 1-3 positive axillary nodes were quite similar. Among patients with 1-3 positive axillary nodes, year of diagnosis and whether postoperative radiotherapy or chemotherapy was added or not did not affect disease-free probability. However, among patients who had four or more positive axillary nodes, those who were admitted after 1976 and who received systemic chemotherapy (90% had CMF) had a much lower probability of developing recurrence.     

T2N0M0乳腺癌治疗方法的选择

探讨Ｔ２Ｎ０Ｍ０乳腺癌治疗方法的选择。方法回顾分析７０２例Ｔ２Ｎ０Ｍ０乳腺癌的淋巴结转移情况、手术方式和辅助治疗的效果。结果Ｔ２Ｎ０Ｍ０乳腺癌临床检查淋巴结假阴性率为３５．２％。各种手术方式在淋巴结阴性时生存率相似。辅助放疗可降低局部复发，辅助化疗在淋巴结转移超过４只者可提高生存率。结论Ｔ２Ｎ０Ｍ０乳腺癌病灶≤３ｃｍ可作改良根治术，病灶＞３ｃｍ且位于中央或内侧应同时清除内乳淋巴结。术后应根据不同情况选择不同的辅助治疗。     

Is avoiding post-mastectomy radiotherapy justified for patients with four or more involved axillary nodes and endocrine-responsive tumours? Lessons from a series in a single institution

BACKGROUND: Current guidelines for post-mastectomy radiotherapy (PMRT) derive largely from extrapolating information from multicentre trials. The aim of this study was to describe outcomes of patients who underwent mastectomy without radiotherapy in a single institution. PATIENTS AND METHODS: 650 patients had total mastectomy and axillary dissection without PMRT between 1997 and 2001. Median follow-up was 65 months. RESULTS: 5-year cumulative incidence of loco-regional recurrence (LRR) was 6.8% (3.0, 8.1, 9.9% in node negative, 1-3, > or =4 positive nodes, respectively). At the multivariate analysis, positive lymph nodes and endocrine non-responsive tumours were found to shorten LRR disease-free survival. In patients with positive hormone receptors, 5-year cumulative incidence of LRR disease-free survival were 2.3%, 7.6% and 7.6% for node negative, 1-3 and > or =4 positive lymph nodes, respectively. The same figures were 5.9%, 10.3% and 20.0% in patients with endocrine non-responsive tumours. CONCLUSIONS: patients with endocrine-responsive tumours treated by mastectomy and complete (level III) axillary dissection have a low risk of LRR even if four or more positive lymph nodes are involved, thus giving rise to doubts on the use of PMRT in this subset of patients. On the other hand, PMRT might play a role for patients with negative hormone receptors and four or more positive nodes.     

影响乳腺癌术后局部复发因素的分析

选择主要临床与组织病理学因素和治疗因素，观察对乳腺癌术后局部复发的影响，２４２２例女性浸润性乳腺癌病人中，３年内局部复发１８２例，复发率７．５％，经过Ｌｏｇｉｓｔｉｃ回归的方法统计，年龄，绝经状态和病理类型不是影响乳腺癌术后局部复发的主要因素，而原发肿块情况，腋下淋巴结转移与否和雌激素受体状态对乳腺癌术后的局部复发的影响有意义，尤以肿块侵犯皮肤或胸壁，腋下淋巴结转移融合，雌激素受体阴性者术后复发的     

Do surgical oncologists achieve lower rates of local‐regional recurrence in node positive breast cancer treated with mastectomy alone?

BACKGROUND AND OBJECTIVE: Adjuvant radiotherapy for node positive breast cancer postmastectomy has been recommended by two previously published randomized controlled trials (RCT). The local-regional recurrence rates in the control arms, however, were considered by some critics to be excessive (> 25% at 10 years). Inadequate surgery, as evidenced by the low number of axillary nodes reported, may have resulted in the high local-regional recurrence rates, allowing for the benefits seen with radiotherapy. Fellowship trained surgical oncologists might provide "better quality" surgery, resulting in lower recurrence rates and thus making adjuvant radiotherapy unnecessary. Our objective was to establish the local-regional control rate postmastectomy in node positive breast cancer patients operated on by surgical oncologists, and to determine if treatment recommendations from previous RCTs are generalizable. METHODS: Node positive stage IIb and IIIa breast cancer patients treated with mastectomy at the Medical College of Virginia Hospitals by surgical oncologists, without adjuvant radiotherapy, and entered into adjuvant chemotherapy trials between 1978 and 1993 were identified retrospectively. Pathology and follow-up records were reviewed. RESULTS: One hundred and thirty-seven patients were identified. A median of 18 axillary nodes was reported with a median of 4 positive nodes. The locoregional recurrence at 10-years was 27% (95% confidence interval, 19-35%). CONCLUSION: Despite some evidence of "better quality" surgery, there was no clinically significant difference in the local-regional recurrence rate in this case series compared to controls in two previous RCTs. Recommendations for postmastectomy radiotherapy should be considered for node positive breast cancers, even if operated upon by surgical oncologists.     

Radiation therapy following mastectomy for axillary node-positive breast cancer: indication of chest wall irradiation

This retrospective study was conducted to determine the indication of chest wall irradiation following mastectomy in axillary node-positive breast cancer patients. Between 1982 and 1993, 103 women with axillary node-positive breast cancer received postoperative radiation therapy following mastectomy using the hockey-stick field, which included the ipsilateral supraclavicular fossa and internal mammary nodes, without the chest wall. Ages ranged from 33 to 73 years (median: 47). Thirty-five patients underwent modified radical mastectomy, 48 radical mastectomy, and 20 extended radical mastectomy. Twenty-two patients had 1-3 positive axillary nodes, and 81 had 4 or more positive axillary nodes. The total doses ranged from 42 to 64 Gy (median 54 Gy) with a daily fraction size of 2 Gy. Adjuvant chemotherapy was given to 75 patients, and hormone therapy was administered to 78 patients. The median follow-up time was 121 months (range, 68-191 months) for the 57 surviving patients. The actuarial overall survival rate and the chest wall control rate at 10 years for all patients were 55% and 85%, respectively. Of the 103 patients, 14 developed chest wall recurrence. In the analysis, status of vascular invasion alone had a significant impact on chest wall control. In patients with definite vascular invasion, 2 of 5 (40%) patients with 1 to 3 positive axillary nodes, and 10 of 31 (32%) with 4 or more positive axillary nodes developed chest wall recurrence. In contrast, no patients without definite vascular invasion developed chest wall recurrence. Factors such as age, menopausal status, pathology, tumor location, extent of resection, estrogen receptor status, total dose, chemotherapy, and hormone therapy did not influence the development of chest wall recurrence. Among node-positive breast cancer patients following mastectomy, those with definite vascular invasion should be delivered chest wall irradiation regardless of the number of positive axillary nodes. In contrast, those without definite vascular invasion need not be administered chest wall irradiation.     

乳腺癌改良根治术后T1-2N1期患者局部区域复发的部位分析

目的 分析乳腺癌改良根治术后T1-2N1患者的局部区域复发(LRR)部位分布,探讨放疗的照射范围。方法 1997年9月至2015年4月中国医学科学院肿瘤医院收治2472例改良根治术后T1-2N1女性乳腺癌患者,均未行新辅助治疗。1898例未行术后放疗的患者纳入本研究,分析患者的局部和区域复发部位。采用Kaplan-Meier法进行局部复发率和区域复发率计算,采用Log-Rank法对影响患者局部复发和区域复发的各因素分别进行单因素分析,纳入单因素分析P值小于0.05的因素进行Cox回归法多因素分析。结果 中位随访时间71.3个月,164例(8.6%)患者发生局部和(或)区域复发。其中复发在锁骨上106例(65%),胸壁69例(42%),腋窝39例(24%),内乳19例(12%)。多因素分析显示年龄(>45岁/≤45岁)、肿瘤位置(其他象限/内象限)、T分期(T1/T2)、腋窝阳性淋巴结数(1个/2~3个)、激素受体(阳性/阴性)是局部复发和区域复发共同的影响因素。结论 乳腺癌改良根治术后T1-2N1期患者的LRR部位主要是锁骨上,其次是胸壁,腋窝和内乳少见。影响局部和区域复发的高危因素基本相似,放疗患者建议照射锁骨上区和胸壁。     

乳腺癌改良根治术后T1-2N1期患者局部区域复发的部位分析

目的 分析乳腺癌改良根治术后T1-2N1患者的局部区域复发(LRR)部位分布,探讨放疗的照射范围。方法 1997年9月至2015年4月中国医学科学院肿瘤医院收治2472例改良根治术后T1-2N1女性乳腺癌患者,均未行新辅助治疗。1898例未行术后放疗的患者纳入本研究,分析患者的局部和区域复发部位。采用Kaplan-Meier法进行局部复发率和区域复发率计算,采用Log-Rank法对影响患者局部复发和区域复发的各因素分别进行单因素分析,纳入单因素分析P值小于0.05的因素进行Cox回归法多因素分析。结果 中位随访时间71.3个月,164例(8.6%)患者发生局部和(或)区域复发。其中复发在锁骨上106例(65%),胸壁69例(42%),腋窝39例(24%),内乳19例(12%)。多因素分析显示年龄(>45岁/≤45岁)、肿瘤位置(其他象限/内象限)、T分期(T1/T2)、腋窝阳性淋巴结数(1个/2~3个)、激素受体(阳性/阴性)是局部复发和区域复发共同的影响因素。结论 乳腺癌改良根治术后T1-2N1期患者的LRR部位主要是锁骨上,其次是胸壁,腋窝和内乳少见。影响局部和区域复发的高危因素基本相似,放疗患者建议照射锁骨上区和胸壁。