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保乳手术阴性切缘切取次数与早期乳腺癌患者临床预后的相关性

  • 摘要: 目的:探讨早期乳腺癌保乳术中获得阴性切缘所需切取次数与患者预后的相关性。方法:收集2009年1月至2016年10月在江苏省南通市第三人民医院行保乳治疗的早期乳腺癌患者的临床资料,回顾性分析获得阴性切缘切取次数与患者年龄、肿块大小、淋巴结状态、激素受体状态、HER-2状态、病理类型及患者预后的相关性。结果:共入组287例接受保乳治疗的早期乳腺癌患者,其中191例(66.6%)经1次切取即获得阴性切缘,65例(22.6%)经2次切取获得阴性切缘,31例(10.8%)经3次及以上切取获得阴性切缘。肿块大小(P=0.010)、病理类型(P<0.001)及HER-2状态(P=0.034)与获得阴性切缘切取次数相关。中位随访5年的局部复发率在1次切取患者(6.3%)、2次切取患者(9.2%)及3次及以上切取患者(25.8%)间差异有统计学意义(P=0.002);而3组患者间中位随访5年的远处转移率(P=0.989)及总生存率(P=0.326)差异无统计学意义。结论:肿块大小、病理类型、HER-2状态与保乳患者获得阴性切缘所需切取次数相关,切取次数与术后局部复发率正相关,但与患者远处转移及总生存率无明显相关。

     

    Abstract: Objective:To analyze the correlation between reexcision frequency of breastconserving surgery negative margins and clinical prognosis of patients with earlystage breast cancer. Methods:We collected the clinical information of early breast cancer patients treated with breast conserving therapy in the Third People's Hospital of Nantong City, Jiangsu Province, from January 2009 to October 2016. We analyzed the relationship between the frequency of re-excision and patient age, tumor size, lymph node status, hormone receptor status, Her-2, pathological type and prognosis of patients retrospectively. Results:In this study, 287 patients with early breast cancer who underwent breastconserving therapy were included. 191 (66.6%) patients acquired negative margins by one excision, 65 (22.6%) patients by twice excision, and 31 (10.8%) patients by thrice or more. Tumor size (P=0.010), pathological type (P< 0.001), and HER-2 state (P=0.034) corrected with the frequency of re-excision. The median followup time was 5 years. Local recurrence rates were 6.3%, 9.2%, and 25.8% for one excision group, twice excision group, and thrice or more excision group, respectively and statistical difference was found among the three groups (P=0.002). No statistical difference was found among the three groups with regard to distant metastasis rates (P=0.989) and overall survival rates (P=0.326). Conclusions:Tumor size, type of pathology, HER-2 status were correlated with the frequency of re-excision required for negative margins in the breastconserving patients. The frequency of re-excision is positively correlated with local recurrence rates, but had no significant relationship with distant metastasis and overall survival rates.

     

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