【摘要】：背景:乳腺癌目前已成為女性惡性腫瘤之首,與西方國(guó)家相比,我國(guó)乳腺癌發(fā)病年齡提前約10年,主要集中于45~55歲,雖然現(xiàn)如今乳腺癌患者趨于年輕化,但隨著人口老齡化進(jìn)展,老年乳腺癌人群相應(yīng)增加。目前國(guó)內(nèi)外對(duì)于老年乳腺癌的年齡定義及治療方案有著諸多爭(zhēng)議,而對(duì)于腋窩淋巴結(jié)的處理亦存在一定意見(jiàn)分歧,目前研究對(duì)腋窩淋巴結(jié)清掃后是否有利于提高老年乳腺癌總生存率、減低局部復(fù)發(fā)率及遠(yuǎn)處轉(zhuǎn)移率仍無(wú)統(tǒng)一定論。目的:探討相比于未行腋窩淋巴結(jié)清掃的老年乳腺癌,腋窩淋巴結(jié)清掃(ALND)手術(shù)能否改善患者預(yù)后,為臨床手術(shù)方案選擇提供一定依據(jù)。方法:檢索已發(fā)表的關(guān)于對(duì)比腋窩淋巴結(jié)清掃與未清掃對(duì)老年乳腺癌預(yù)后影響相關(guān)文獻(xiàn),進(jìn)行數(shù)據(jù)提取后使用Meta分析軟件對(duì)納入文獻(xiàn)進(jìn)行薈萃分析,評(píng)價(jià)腋窩淋巴結(jié)清掃對(duì)老年乳腺癌術(shù)后總生存率、無(wú)病生存率、腫瘤特異死亡率、同側(cè)腋窩復(fù)發(fā)率、局部復(fù)發(fā)率及遠(yuǎn)處轉(zhuǎn)移率的影響。結(jié)果:共計(jì)納入乳腺癌病例6943例,其中未接受ALND者1671例,接受ALND者5272例,納入病例基本為臨床診斷早期、腋窩淋巴結(jié)陰性的老年乳腺癌患者。行Meta分析后發(fā)現(xiàn)ALND可降低老年乳腺癌患者術(shù)后腋窩復(fù)發(fā)轉(zhuǎn)移率,其合并RR值為0.12(95%CI 0.03~0.43,P=0.001),有統(tǒng)計(jì)學(xué)意義。但并未發(fā)現(xiàn)兩組患者在總生存率、腫瘤特異死亡率、局部復(fù)發(fā)率及遠(yuǎn)處轉(zhuǎn)移率上有明顯差異。結(jié)論:對(duì)于早期的可行手術(shù)治療的老年乳腺癌患者,腋窩淋巴結(jié)清掃并不能提高患者生存率及降低腫瘤特異死亡率。因此,對(duì)于早期老年乳腺癌患者,避免腋窩淋巴結(jié)清掃(ALND)可成為合理的手術(shù)選擇方案。目前關(guān)于腋窩淋巴結(jié)清掃對(duì)老年乳腺癌預(yù)后相關(guān)文章仍較少,需待更多、更大型臨床研究證實(shí)。
[Abstract]:Background: breast cancer has become the first female malignant tumor at present. Compared with the western countries, the onset age of breast cancer in China is about 10 years earlier, mainly concentrated at 45 to 55 years old, although nowadays breast cancer patients tend to be younger. However, with the aging of the population, the number of elderly breast cancer increased accordingly. At present, there are many controversies at home and abroad on the definition of age and treatment of senile breast cancer, and there are some differences of opinion on the treatment of axillary lymph nodes. Whether the axillary lymph node dissection can improve the overall survival rate of breast cancer and reduce the local recurrence rate and distant metastasis rate is still unclear. Objective: to investigate whether axillary lymph node dissection (ALND) can improve the prognosis of elderly breast cancer patients without axillary lymph node dissection. Methods: the published literatures on the prognostic effects of axillary lymph node dissection and undissection on the prognosis of elderly breast cancer were retrieved and Meta-analysis software was used for meta-analysis. To evaluate the effects of axillary lymph node dissection (axillary lymph node dissection) on the overall survival rate, disease-free survival rate, tumor-specific mortality, ipsilateral axillary recurrence rate, local recurrence rate and distant metastasis rate of elderly breast cancer. Results: a total of 6943 cases of breast cancer were included, of which 1671 cases were not accepted ALND and 5272 cases were received ALND. The patients were basically aged breast cancer patients with early clinical diagnosis and negative axillary lymph nodes. Meta-analysis showed that ALND could reduce the rate of axillary recurrence and metastasis in elderly patients with breast cancer, and the combined RR value was 0.12 (95 CI 0.03 0. 43 P0. 001), which was statistically significant. However, there was no significant difference in overall survival rate, tumor specific mortality, local recurrence rate and distant metastasis rate between the two groups. Conclusion: axillary lymph node dissection can not improve the survival rate and decrease the tumor specific mortality of the aged breast cancer patients. Therefore, to avoid axillary lymph node dissection (ALND) is a reasonable choice for early aged breast cancer patients. At present, there are few articles about axillary lymph node dissection in the prognosis of elderly breast cancer.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 熊念忠;;腋窩清掃手術(shù)對(duì)早期老年乳腺癌患者預(yù)后的影響分析[J];中國(guó)繼續(xù)醫(yī)學(xué)教育;2015年24期

2 張新棟;;腋窩清掃手術(shù)對(duì)早期老年乳腺癌患者預(yù)后的影響[J];河南外科學(xué)雜志;2015年01期

3 韓穎;;老年乳腺癌的特點(diǎn)及其化學(xué)治療策略[J];癌癥進(jìn)展;2014年03期

4 趙衛(wèi)紅;徐兵河;李青;張頻;孫燕;;70歲以上老年女性乳腺癌患者的特點(diǎn)和預(yù)后分析[J];中華腫瘤雜志;2006年05期

5 盧曉紅;青、老年乳腺癌淋巴結(jié)轉(zhuǎn)移規(guī)律的分析[J];中國(guó)腫瘤臨床與康復(fù);2002年06期

，

本文編號(hào)：2127092