摘要:目的：探讨高频电刀在乳腺癌手术皮瓣游离中的临床应用及其功率大小对术后皮瓣坏死的影响。方法：回顾性分析2003年1月至2008年9月,在我院154例行乳腺癌改良根治术患者的临床资料,其中乳腺刀组（A组）37例,小功率电刀组（B组）60例,大功率电刀组（C组）57例,对比分析各组皮瓣坏死情况。结果：共发生皮瓣坏死35例,其中A组用乳腺刀游离皮瓣6例（6/37）,B组用小功率电刀（18～22W）游离皮瓣9例（9/60）,C组用大功率（≥28W）电刀游离皮瓣20例(20/57),B组与A组比较差异无显著意义(Ｐ＞005),C组与A、B组比较差异有显著意义(Ｐ＜005);而B、C组与A组比较,游离皮瓣时出血量明显减少,差异有显著性意义（Ｐ＜005）。结论：合理应用高频电刀游离皮瓣具有术中出血少,术后恢复快的优势,但若功率过高,则会增加皮瓣坏死率。Abstract: Objective: To Analyse influence of Skin Flap Necrosis after Operation of Breast Cancer with different power of radioknife. Methods：The clinical data of 154 breast cancer patients received surgery operation trea tment was analysed retrospectively, among them there are 37 patients operation with lancet (group A), there were 60 patients operation with littlepower radioknife (group B) and there were 57 patients operation with highpower radioknife (group C). Results：There were 35 cases (22.73％) suffured from skin flap necrosis among 154 breast cancer cases received surgery operation. There were 6 cases（6/37）in group A, 9 cases（9/60）in group B and 20 cases（20/57）in group C. Group B and group C has littler hemorrhage in operation compare with group C (Ｐ＜005) . Conclusion： Radioknife for skin flap decoherence in operation of breast cancer can decrease hemorrhage but highpower radioknife will increase necrosis of skin flap.
Objective To study the long-term effect of neoadjuvant chemotherapy on advanced breast cancer. Methods The CAF neoadjuvant chemotherapy 〔CTX 500 mg/m2（1st day, 8th day), 5-FU 500 mg/m2（1st day, 8th day), and ADM 30 mg/m2 (1st day) every 3 weeks〕 was carried out in 31 breast cancer patients (stageⅢ,Ⅳ) for 2 cycles before operation, compared with 30 patients (stage Ⅲa) whose therapies were never done and operations could be feasible. Results The overall response rate was 87.1%(27/31). The stages of 19 patients among 31 (61.3%) declined (6 patients to stage Ⅲa, 8 to stageⅡb, 4 to stageⅡa, 1 to stage 0, 1 to complete response and none to pathological complete response). The diseasefree survival time of the patients was 56.3 months which was obviously longer than that of the patients without neoadjuvant chemotherapy (43.5 months, P＜0.05). The 5-year diseasefree survival rate of the patients with neoadjuvant chemotherapy was 38.7% which was a little higher than that (33.3%) of the patients without the chemotherapy, and the two groups had no significant difference. Conclusion The neoadjuvant chemotherapy can reduce the stages of patients with advanced breast cancer, obviously prolong the diseasefree survival time of patients, and reduce or delay recurrence or metastasis.
The report of brachial plexus injuries following radical mastectomy in patients with breast cancer was rare even though the operation was a main measure in treating with breast cancer. Nine patients treated from Oct. 1989 to Feb.1991 were summarized. The results were not ideal.
Objective To systematically evaluate the clinical effectiveness and safety of capecitabine plus docetaxel in the treatment of patients with metastatic breast cancer where anthracycline has failed as a treatment. Methods We electronically searched PubMed, EMBASE, the Cochrane Library (2008, issue 4), and CBM to Sept. 2008. Randomized controlled trials (RCTs) and quasi-RCTs about capecitabine plus docetaxel combination therapy in anthracycline-pretreated patients with metastatic breast cancer were identified. Study selection and analyses were undertaken according to the Cochrane Handbook, and RevMan 5.0 was applied for statistical analyses. The following was studied: total survival time, the development time of disease, reaction rate, the mid-survival time, adverse events and quality of life. Results Three RCTs involving 672 patients with metastatic breast cancer were included. The results of meta-analyses showed that the overall survival (MD=3.00, 95%CI 1.64 to 4.36), disease time to progression (MD=1.85, 95%CI 1.15 to 2.55), and the response rate (RR=1.29, 95%CI 1.09 to 1.52) were superior in the combination arm to the docetaxel alone arm. Conclusion The current evidence available shows that the combination of capecitabine and docetaxel may significantly improve the short-term efficacy comparing with docetaxel alone. However, adverse events and long-term efficacy are not clear; more high-quality RCTs should be conducted.
Objective To evaluate the effect of neoadjuvant chemotherapy (NAC) on breast conserving surgery and the outcomes of treatment for women with operable breast cancer. Methods We searched The Cochrane Library (Issue 1, 2007), CENTRAL (1970 to 2007), PUBMED (1978 to March 2007), CBM (1978 to 2006), CNKI (1994 to 2007), CMCC (1994 to May 2007) and other relevant databases and journals. We identified randomized controlled trials (RCTs) comparing NAC plus breast conserving therapy (BCT) or mastectomy versus BCT or mastectomy plus postoperative chemotherapy in women with operable breast cancer. Two reviewers independently assessed trial quality and extracted data. Meta-analyses were performed for homogenous studies by using The Cochrane Collaboration’s RevMan 4.2.10. Results Three eligible studies involving 2 391 women were included. The median follow-up in the studies ranged from 17 to 137 months. The methodological quality of the three RCTs was high. Meta-analyses showed that NAC had no significant effect on overall survival (OS) (RR 0.99, 95%CI 0.92 to 1.07), disease-free survival (RR 1.04, 95%CI 0.94 to 1.15) and ipsilateral breast cancer recurrence (RR 1.34, 95%CI 0.84 to 2.13). Two RCTs revealed that NAC significantly increased the rate of BCT in operable breast cancer patients, but the other RCT reported similar rates of BCT in both groups. One RCT indicated that NAC did not increase the incidence of surgery-related local complications. Conclusions NAC is safe for the treatment of women with operable breast cancer, which may increase the rate of BCT and help to evaluate chemosensitivity. There is insufficient evidence to assess the effect of NAC on conserving surgery procedure and survival rate in operable BCT patients. More large-scale RCTs are needed to define further the role of NAC in the treatment of operable breast cancer patients.
Objective To explore the expressions of androgen （AR） and Stathmin in triple negative breast cancer （TNBC） and analyze the correlation between these expressions and clinicopathologic features. Methods Eighty-three patients who were diagnosed as TNBC and met the inclusion criteria from 2005 to 2009 in the Sichuan Provincial People’s Hospital were collected retrospectively. The expressions of AR and Stathmin in the TNBC tissues by using the method of EnVision immunohistochemistry. The correlation between AR or Stathmin expression and age， tumor size， lymph node status， or histological grade was analyzed by Spearman test. Results The AR and Stathmin positive expression rates in the patients with TNBC were 37.3% （31/83） and 98.8% （82/83）， respectively. The AR expression was positively correlated with age（rs=0.302， P=0.006）and pathological grade （rs=0.225， P=0.041）， but was not correlated with tumor size or lymph node status. The Stathmin expression was not correlated with age， tumor size， lymph node status， or pathological grade （P＞0.05） . Conclusions The AR expression is correlated with the age or pathological grade but Stathmin expression was all not correlated with the clinicopathologic features. AR or Stathmin as a prognosis indicator in patients with TNBC are needed to more research.
Objective To summarize the recent studies on diagnosis and treatment for pregnancy-associated breast cancer （PABC） to provide evidence for diagnosis and treatment for PABC. Methods By PubMed， Medline， and CNKI retrieval system， with “pregnancy-associated breast cancer or PABC， diagnosis of pregnancy-associated breast cancer or PABC， treatment of pregnancy-associated breast cancer or PABC” as key words to retrieval for the recent researches about PABC. All of the publications about studies on diagnosis and treatment for PABC were reviewed and summarized. Results Diagnosis of PABC included ultrasound， mammography， magnetic resonance imaging， needle biopsy， and so on， and the treatment contained surgery， chemotherapy， endocrine therapy， radiation therapy， and targeted therapy. However， when diagnosis and treatment for PABC involved， the impact to patients with pregnancy and fetus must be considered in priority. Conclusions By reviewing the studies of relevant papers about diagnosis and treatment for PABC which can provide a clinical guidance for clinicians. Usage of bevacizumab and lapatinib still needs to further be studied.
Objective To explore the characters and therapy of the triple-negative breast cancer （TNBC）. Methods The pertinent literatures with key words “triple-negative breast cancer”，“diagnosis”，and “therapy” were retrieved and reviewed. Results TNBC was a subtype of breast cancer characterized by negative expressions of estrogen receptor （ER），progesterone receptor （PR），and human epidermal growth factor receptor-2 （HER-2）. The clinicopathologic feature and prognosis of TNBC were distinct from other breast cancer. The age of onset was younger，disease free survival and total survival rate were lower in the patients with TNBC. At present， the therapy guideline was lack of TNBC，which referred to the non-TNBC，including local surgery，systemic chemotherapy，and the target therapy was at the clinical trial stage. Conclusions TNBC is one of heterogeneity characteristics for the breast cancer，which has extra much difference. For improving the TNBC prognosis，we hope that more and more significant markers to TNBC in the future are found，which are useful to make individuation treatment.
ObjectiveTo explore the expressions of survivin, p53, and Ki67 in recurrence or metastasis breast cancer tissue, and explore their correlations and clinical significance. MethodsEighty-six patients with the chest wall local recurrence, axillary or supraclavicular lymph node metastases get treated in this hospital between January 2005 and January 2010 were excised and the expressions of survivin, p53, and Ki67 were detected by immunohistochemistry test, then compared them between the recurrence and metastasis breast cancer tissues and the primary breast cancer tissues. ResultsThe positive expression rate of survivin, p53, and Ki67 in the recurrence and metastasis breast cancer tissues were significantly higher than those in the primary breast cancer tissues, survivin: 90.70% (78/86) versus 61.63% (53/86), χ2=20.014 895, Plt;0.001; p53: 68.60% (59/86) versus 52.33% (45/86), χ2=4.766 968, Plt;0.05; Ki67: 62.79% (54/86) versus 46.51% (40/86), χ2=4.597 927，Plt;0.05. The positive expression rates of survivin in the recurrence and metastasis patients with p53, Ki67 negative expression were significantly higher than those of the primary breast cancer tissue (70.37% versus 24.39%, χ2=14.071 113, Plt;0.05; 75.00% versus 39.13%, χ2=6.540 373, Plt;0.05). The correlation coefficient of survivin with p53 and Ki67 positive expressions in the recurrence and metastasis breast cancer tissue and the primary breast cancer tissue were 0.876 214, 0.773 643 and 0.725 164, 0.698 112, respectively, Plt;0.05. ConclusionThe positive expression rates of survivin, p53, and Ki67 which increase in recurrence and metastasis breast cancer tissue indicate bad prognosis.
Objective To study the risk factors for contralateral breast cancer (CBC) in women after regular treatment of the primary breast cancer. Methods Between January 1997 to December 2002, the clinical data of 340 breast cancer patients at our institution were retrospectively analyzed. In all the patients a detailed analysis was carried out with respect to age, operation type, radiation therapy technique and dose, the use of chemotherapy or hormone therapy, and other clinicopathologic characteristics. The KaplanMeier method was used to estimate the actuarial rate of CBC. The Cox proportional hazard regression model was used to estimate the relative risk factors of CBC. Results Fourteen cases were diagnosed to be CBC, thus overall incidence of CBC was 4.1%. Ten-year CBC incidence (2.7%) was higher than 5-year incidence of CBC (1.4%). Univariate analysis showed that the risk factors of CBC at 5-year and 10-year included: ≤45 years old, medullary carcinoma, family history of breast cancer and being taken without endocrine therapy (P＜0.05), while chemotherapy and radiotherapy were not risk factors of CBC (P＞0.05). Mutivariate analysis showed that ≤ 45 years old and being internal breast radiotherapy were independent risk factors of CBC at 5-year and 10-year (P＜0.05). Conclusions CBC may occur in these primary breast cancer patients with age ≤45 years old, medullary carcinoma, family history of breast cancer. In order to reduce the incidence of CBC, endocrine therapy rather than internal breast radiotherapy should be performed in early breast cancer patients.