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目的探讨新辅助化疗及保乳手术在Ⅱ,Ⅲ期乳腺癌治疗中的作用。方法对观察组46例Ⅱ,Ⅲ期乳腺癌经新辅助化疗后接受保乳手术治疗的患者进行随访观察,并与59例患者对照研究。新辅助化疗方案为表阿霉素60 mg/m2第1天静脉注射,紫杉醇150 mg/m2。第2天持续3 h静脉滴注,21 d为1个疗程。保乳手术方式为象限切除或肿块局部广泛切除联合腋窝淋巴结清除。对照组常规行根治性切除术。术后对乳房外形及局部复发、远处转移进行随访观察。结果新辅助化疗后,观察组术前肿瘤病灶临床完全缓解(CR)9例,部分缓解(PR)37例。术后病理学检查发现,观察组癌细胞均有不同程度的变性、坏死,细胞间质水肿,纤维增生,炎性细胞浸润;其中病理完全缓解(PCR)4例。对保乳综合治疗(放疗+化疗)结束后1年的31例患者进行外形评估,其中优19.4%(6/31),良58.1%(18/31),差22.6%(7/31)。观察组局部复发率为8.7%(4/46),对照组为6.8%(4/59),两组比较无统计学意义(P>0.05);观察组远处转移率为6.5%(3/46),与对照组(15.3%,9/59)比较无统计学意义(P>0.05)。结论新辅助化疗后行保乳手术治疗Ⅱ,Ⅲ期乳腺癌基本是安全的,可达到根治性手术的效果。新辅助化疗,规范化切除,术后放疗、化疗是保乳治疗成功的关键。
Objective To investigate the role of neoadjuvant chemotherapy and breast-conserving surgery in the treatment of stage Ⅱ and Ⅲ breast cancer. Methods A total of 46 patients with stage Ⅱ and Ⅲ breast cancer undergoing neoadjuvant chemotherapy in the observation group were followed up and compared with 59 patients. Neoadjuvant chemotherapy schedule epirubicin 60 mg / m2 intravenous injection on day 1, paclitaxel 150 mg / m2. Day 2 continued 3 h intravenous infusion, 21 d for a course of treatment. Breast-conserving surgery for the quadrant resection or mass local excision combined with axillary lymph node clearance. Control group conventional radical resection. Postoperative breast shape and local recurrence, distant metastasis were followed up. Results After neoadjuvant chemotherapy, there were 9 cases of complete remission (CR) and 37 cases of partial remission (PR) in the observation group before operation. Postoperative pathological examination found that the observation group of cancer cells have varying degrees of degeneration, necrosis, interstitial edema, fibrosis, inflammatory cell infiltration; pathological complete remission (PCR) in 4 cases. Overall, 31 patients underwent breast conservative treatment (radiotherapy + chemotherapy) 1 year after the end of the evaluation. The results were excellent in 19.4% (6/31), good in 58.1% (18/31) and poor in 22.6% (7/31). The local recurrence rate was 8.7% (4/46) in the observation group and 6.8% (4/59) in the control group, with no significant difference between the two groups (P> 0.05). The distant metastasis rate in the observation group was 6.5% (3 / 46) compared with the control group (15.3%, 9/59) (P> 0.05). Conclusion Neoadjuvant chemotherapy followed by breast-conserving surgery for stage Ⅱ, Ⅲ breast cancer is basically safe, and can achieve the effect of radical surgery. Neoadjuvant chemotherapy, standard resection, postoperative radiotherapy, chemotherapy is the key to breastfeeding success.