發(fā)布時間：2018-12-15 07:52

【摘要】：目的：揭示三陰乳腺癌(TNBC)患者的臨床病理特征,探討提高患者術(shù)后無復(fù)發(fā)生存期(DFS)和總生存時間(0S)的策略。方法：回顧性分析廣西醫(yī)科大學(xué)第一附屬醫(yī)院胃腸腺體外科2010年1月至2014年1月之間65例TNBC患者的臨床資料、治療方法,病理特點及預(yù)后。結(jié)果：本組65例TNBC占同期我院乳腺癌的12.7%(65/512),患者年齡25～70歲,平均46.3歲,腫瘤最大徑1.0～7.0 cm,平均3.5cm。腋窩淋巴結(jié)轉(zhuǎn)移率43.1%(28/65)。其中浸潤性導(dǎo)管癌54例(83.1%),導(dǎo)管內(nèi)癌3例(4.6%),其他類型8例(12.3%),包括化生性癌2例,髓樣癌1例,乳頭狀癌4例,透明細(xì)胞癌1例。組織學(xué)分級：I級2例(3.1%),II級44例(67.7%),Ⅲ級19例(29.2%)。臨床分期(TNM)：I期15.4%(10/65),II期56.9%(37/65),Ⅲ期27.7%(18/65)。行乳腺癌改良根治術(shù)45例,保乳手術(shù)12例,全乳切除術(shù)加腋窩前哨淋巴結(jié)活檢術(shù)(SLNB)8例。接受全身化療62例,其中鉑類與紫杉醇類聯(lián)合方案新輔助化療占14.5%(9/62),以葸環(huán)類為主或與紫杉類聯(lián)合方案輔助化療占82.3%(51/62),予FEC聯(lián)合輔助化療占3.2%(2/62)。術(shù)后隨訪12月～40月,平均隨訪22.7個月,術(shù)后胸壁復(fù)發(fā)3例,對側(cè)乳腺復(fù)發(fā)1例,行復(fù)發(fā)灶或?qū)?cè)乳腺再切除術(shù)和二線化療。術(shù)后肺轉(zhuǎn)移2例,肝轉(zhuǎn)移1例,骨、腦等多發(fā)臟器轉(zhuǎn)移4例。均予二線化療控制病情。因乳腺癌死亡4例。結(jié)論：TNBC腫瘤較大,腋窩淋巴結(jié)轉(zhuǎn)移率高,臨床分期晚,以浸潤性導(dǎo)管癌多見,Ki-67蛋白質(zhì)高表達(dá),是侵襲性強(qiáng)的惡性腫瘤。TNBC患者的腋窩淋巴結(jié)轉(zhuǎn)移、病理組織類型與預(yù)后有顯著相關(guān)性。TNBC術(shù)后遠(yuǎn)處臟器轉(zhuǎn)移幾率高,且發(fā)生時間早,預(yù)后差。化療是唯一可選擇的全身輔助治療方案,進(jìn)一步增加TNBC患者接受新輔助化療的比例,通過提高新輔助化療的pCR,是提高TNBC治療水平的希望。
[Abstract]:Objective: to reveal the clinicopathological features of (TNBC) patients with triple yin breast cancer, and to explore the strategy of increasing the recurrence free survival time (DFS) and total survival time (0 S). Methods: the clinical data, treatment methods, pathological features and prognosis of 65 patients with TNBC in the first affiliated Hospital of Guangxi Medical University from January 2010 to January 2014 were retrospectively analyzed. Results: 65 cases of TNBC accounted for 12.7% (65 / 512) of breast cancer in our hospital in the same period. The age of the patients was 2570 years old (mean 46.3 years) and the maximum diameter of tumor was 1.0 cm, (3.5 cm). Axillary lymph node metastasis rate was 43.1% (28 / 65). There were 54 cases of invasive ductal carcinoma (83.1%), 3 cases of intraductal carcinoma (4.6%), 8 cases of other types (12.3%), including 2 cases of metaplastic carcinoma, 1 case of medullary carcinoma, 4 cases of papillary carcinoma and 1 case of clear cell carcinoma. Histological grade: grade I 2 cases (3.1%), II 44 cases, 67.7%), grade 鈪，

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