Ⅱ期乳腺癌765例临床病理分析

于冬; 孟洁; 宁连胜; 牛昀

摘要: 目的:探讨Ⅱ期乳腺癌外科手术的远期疗效。方法:我院自1973年1月到1983年12月共手术治疗765例Ⅱ期乳腺癌,占经治可手术女性乳腺癌2665例的28.7%。其中肿瘤≤2cm者(T₁N_1b)50例,2.1～3cm者362例,3.1～4cm者238例,4.1～5cm者115例。行扩大根治术仅2例,传统根治术434例,改良根治术280例和全乳切除术49例。按病理类型、淋巴结转移以及生存情况进行分析研究。结果:临床为N₀者病理检查31%见淋巴结转移,T₁N_1b者59.2%阳性,T2N1者56.9%阳性。本组病例的3年复发率为4.2%;5年生存率、健在率分别为77.4%及70.0%;10年生存率、健在率分别为62.4%及60.2%。其中非浸润性癌,早期浸润性癌,浸润性特殊型癌及浸润性非特殊型癌3年复发率分别为0%、2.1%、2.0%及4.8%;5年生存率和5年健在率分别为93.3%、90.0%,80.9%、78.7%,86.0%、82.0%及75.6%、67.4%;10年生存率和10年健在率分别为89.7%、89.7%,75.6%、75.6%,78.0%、72.0%及58.8%、56.7%。原发癌≤2cm(T₁N_1b)、2.1～3cm、3.1～4cm及4.1～5cm者的3年复发率分别为10.0%、2.8%、4.3%及6.3%;5年生存率和5年健在率分别为60.0%、50.0%,82.1%、74.4%,75.4%、68.5%及74.5%、68.2%;10年生存率和10年健在率分别为46.9%、42.9%,68.3%、66.0%,57.1%、54.9%及61.7%、60.7%。结论:Ⅱ期乳腺癌治疗结果与术式无明显相关,降低3年复发率,提高5年、10年生存率、健在率的关键是辅助化疗.

Abstract: Objective : To study the long -term result of stage " breast cancer treatment by surgery. Methods : During the period of 1973 to 1983, 765 patients with stage " breast cancer were treated surgically. They accounted for 28.7% of 2665 cases of primary breast cancer treated at this hospital during the same period. In 50 cases, the tumor were ≤2cm (T1N1bM0) in diameter, 362 tumors were 2.1~3cm, 238 tumors were 3.1~4cm and 115 tumors were 4.1~5cm. Margottrni operation was done in 2 cases, halsted in 434, modified radical mastectomy in 280, and simple mastectomy in 49 cases.According to pathological type, lymph node metastasis and survival condition we study stage Ⅱbreast cancer. Results : Lymph node metastases were found in 31% in T2No cases, 59.2% in T1N1b cases and 56.9% in T2N1 cases. The total clinical 3-year recurrence rate was 4.2%, 5-year survival rate and 5 -year NED rate respectively were 77.4% and 70.0%; 10-year survival rate and 10 -year NED rate were 62.4% and 60.2%.3 -year recurrence rate of noninfiltrative carcinoma, early infiltrative carcinoma, infiltrative specific carcinoma and nonspecific carcinoma respectively were 0%, 2.1%, 2.0% and 4.8%; 5-year survival rate of noninfiltrative carcinoma, early infiltrative carcinoma, infiltrative specific carcinoma and nonspecific carcinoma respectively were 93<3% , 80<9% , 86<0% and 75<6% ; 5 -year NED rate of noninfiltrative carcinoma, early infiltrative carcinoma, infiltrative specific carcinoma and nonspecific carcinoma respectively were 90.0%, 78.7％, 82.0% and 67.4%; 10-year survival rate of noninfiltrative carcinoma, early infiltrative carcinoma, infiltrative specific carcinoma and nonspecific carcinoma respectively were 89.7%, 78.6%, 78.0% and 58.8%; and 10-year NED rate of noninfiltrative carcinoma, early infiltrative carcinoma, infiltrative specific carcinoma and nonspecific carcinoma respectively were 89.7%, 75.6 %, 72.0% and 56.7%. The 3-year recurrence rate of the primary carcinoma ≤2cm (TlNlb), 2.1~3cm, 3.1~4cm and 4.1~5cm respectively were 10.0%, 2.8%, 4.3% and 6.3%;5-year survival rate of the primary carcinoma ≤2cm (TINlb), 2.1~3cm, 3.1~4cm and 4.1 -5cm respectively were 60.0%, 82.1% 75.4% and 74.5%; 5-year NED rate of the primary carcinoma ≤2cm(T1N1b), 2.1-3cm, 3.1-4cm and 4.1-5cm respectively were 50.0%, 74.4%, 68.5% and 68.2%; 10-year survival rate of the primary carcinoma ≤2cm (T1N1b), 2.1~3cm, 3.1~4cm and 4.1~5cm respectively were 46.9% ,68.3%, 57.1% and 61.7% ; and 10-year NED rate of the primary carcinoma ≤2cm(T1N1b), 2.1~3cm, 3.1~4cm and 4.1~5cm respectively were 42.9%, 66.0%, 54.9% and 60.7%. Conclusion: No relation of stage II breast cancers was found between the long term result and the type of operation. Key of decreased recurrence and increased surrival, and NED rate was adjuvat chemotherapy.

Ⅱ期乳腺癌765例临床病理分析

Clinicopathological Analysis of 765 Stage Ⅱ Breast Cancers