摘要
目的 探讨早期乳腺癌乳腺保全性手术时腋窝淋巴结清扫与不清扫对治疗结果的影响。方法 将66 例Ⅰ～Ⅱ期乳腺癌行乳腺功能保全性手术的患者分为2 个组:乳腺肿块局部切除+腋窝清扫组( 局部切除+ 腋清组)36 例和乳腺肿块局部切除组30 例。所有病例均用乳腺切线野给予锁骨上下区、腋窝、内乳淋巴链区照射,瘤床行推量补充照射。结果 临床检查腋窝淋巴结阴性的28例,术后病理证实为阳性的6 例(21.4 % );T1 ,T2 期病例腋窝淋巴结阳性率分别为30.0% (6/20) ,43.8% (7/16) 。局部切除+ 腋清组和局部切除组乳腺复发分别为4 例(11.1% ) 和7 例(23.3% ) ,区域淋巴结复发分别为2 例和3 例,2 个组乳腺局部和区域淋巴结复发率差异无显著意义( P> 0 .05) 。局部切除+ 腋清组和局部切除组远地转移分别为6 例(16 .6% ) 和7 例(23.3% )( P> 0.05)。局部切除+ 腋清组与局部切除组的总生存率和无瘤生存率经KaplanMeier 法分析,Logrank 检验差异无显著意义。局部切除+ 腋清组和局部切除组上肢浮肿发生率分别为12 例(33 .4% ) 和5 例(16.7 %) 。结论 在早期乳腺癌乳腺保全性手术+ 术后放射治疗中,腋窝淋巴结清扫对腋窝淋巴结阴性的T1 期和部分T2 期病例是不必要的。
Objective To analyse the treatment results of breast conservative surgery with or without axillary dissection plus radiotherapy for early breast cancer and ascertain the value of axillary dissection. Methods Between 1985 and 1993, 66 patients with stageⅠorⅡbreast cancer were divided into two groups: lumpectomy with axillary dissection(36 patients); lumpectomy without axillary dissection(30 patients). The whole breast, chest wall and regional lymph nodes were irradiated, followed by tumor bed boost for all patients. Results Axillary lymph node metastasis were found in 6 cases of 28 patients with clinically negative axillary lymph nodes after surgery. The rates of axillary lymph nodes involvement in stage T 1 and T 2 were 30.0%(6/20) and 43.8%(7/16) respectively. The recurrence rates of breast and regional lymph node in the axillary dissection group and no axillary dissection group were 4 (11.1%),7 ( 23.3% ) and 2(5.5%),3(10.0%)respectively (P>0.05). The distant metastasis rates in the two groups were 6( 16.6% )and 7(23.3%)(P>0.05). There was no significant difference in the overall survival and disease free survival between these two groups (P>0.05). The risk of arm edema in the axillary dissection group and no axillary dissection group were 12(33.4%)and 5 ( 16.7% ) respectively. Conclusions It is unnecessary to perform axillary dissection for stage T 1 and some T 2 cases with clinically negative axillary lymph nodes. Lumpectomy plus postoperative radiotherapy is comparable to lumpectomy plus axillary dissection in local control,distant metastasis and survival.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
1999年第4期215-218,共4页
Chinese Journal of Radiation Oncology
关键词
乳腺癌
放射疗法
淋巴结切除术
Breast neoplasms/surgery Breast neoplasms/radiotherapy lymphnode dissection
