摘要
目的:分析老年乳腺癌保留乳房手术治疗的临床效果及预后,进而探讨腋淋巴结清扫术在老年乳腺癌中的意义。方法:对1986年12月～2006年12月在天津医科大学附属肿瘤医院行保留乳房手术治疗的112例乳腺癌患者的临床病理资料进行分析。患者年龄均≥60岁,均接受乳腺癌局部广泛切除术,其中59例同时行腋窝淋巴结清扫术,即保乳手术。结果:51.8%(58/112)的患者合并其它疾病。行腋窝淋巴结清扫术的临床N_0期患者中,30.6%(15/49)的患者累及腋窝,仅2.0%(1/49)的患者淋巴结转移数>3枚。中位随访31个月(7～288个月),保乳手术组与局部广泛切除术组5年累积生存率分别为84.0%和82.8%(P=0.703);10年累积生存率分别为70.9%和55.0%(P=0.382),差异均无统计学意义。其中临床触诊腋淋巴结阴性患者中49例行保乳手术,36例行局部广泛切除术,术后5年累积生存率分别为84.7%和84.9%(P=0.795),差异亦无统计学意义。保乳手术组与局部广泛切除术组5年复发率分别为3.7%和8.2%(P=0.258)。结论:保留乳房手术术后并发症少,恢复快,适用于老年乳腺癌患者。腋淋巴结清扫并未明显增加老年乳腺癌尤其是临床触诊腋淋巴结阴性患者的生存率。
Objective： To analyze the clinical results and prognosis of 112 elderly breast cancer patientstreated with breast conserving surgery and to explore the significance of axillary lymph node dissection（ALND）. Methods： During December 1986 and December 2006, 112 breast cancer patients aged ≥ 60 yearswere treated with breast conserving surgery in our hospital. All of these patients underwent breast conservingsurgery with axillary dissection （59 patients） or without axillary dissection （53 patients）. Results： Fifty-eight（51.8%） patients had comorbidities including coronary heart disease, hypertension, diabetes, etc. Invasiveductal carcinoma was the major pathological type （63.4% ）. Immunohistochemical staining showed thatestrogen or progesterone receptor was positive in 86.4% patients. The postoperative contour of the breastwas satisfactory. Of the 49 patients who were clinically negative for lymph node involvement but underwentaxillary dissection, 15 （30.6%） had axillary lymph node metastasis. And of the 15 cases with lymph nodemetastasis, 14 （28.6%） had 3 or less than 3 involved lymph nodes, and only 1 patient （2.0%） had more than 3involved lymph nodes. After a median follow up of 31 months （7 to 288 months）, the 5-year cummulativesurvival rates of breast conserving surgery group and wide local excision group were 84.0% and 82.8% （ P=0.703）. The 10-year cummulative survival rates were 70.9% and 55.0% （P=0.382）. For patients clinicallynegative for axillary lymph node metastasis, the 5-year cummulative survival rates were 84.7% and 84.9% （P=0.795）. The 5-year recurrence rates were 3.7% and 8.2% for the two groups （P=0.258）. Conclusion： Breastconserving surgery is suitable for the treatment of elderly breast cancer patients, with lower complication rate.Old women with breast cancer especially those who have no evidence of axillary lymph node involvement canbe safely treated by breast conserving surgery without axillary dissection. Immediate axillary dissection is notnecessary but should be performed in the small percentage of patients who later develop metastasis in axillary lymph nodes.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2009年第19期1090-1093,共4页
Chinese Journal of Clinical Oncology
关键词
老年
乳腺肿瘤
保乳治疗
腋窝淋巴结清扫术
Elderly
Breast neoplasm
Breast conserving therapy
Axillary lymph node dissection
