【摘要】 目的探讨125Ⅰ粒子术中植入在早期乳腺癌患者联合治疗中的临床价值。方法回顾性分析海南医学院附属医院2005年1月—2008年12月53例行保乳手术治疗的乳腺癌患者的临床病理资料,根据125Ⅰ粒子术中植入与否比较无病生存期(Disease-free survival,DFS)和总生存期(Overall survival,OS)。结果 39例女性早期乳腺癌患者均给予保乳术+术中植入125Ⅰ粒子治疗,按照TPS方案,向患侧胸骨旁线的后内侧及胸廓内动脉周围纵行植入一排125Ⅰ粒子(约10余枚)和向腋静脉水平以上至锁骨上下区域植入125Ⅰ粒子(约10余枚)。单因素分析显示125Ⅰ粒子、雌激素受体(ER)、孕激素受体(PR)状态、淋巴结转移率(LNR)、内分泌治疗均与DFS、OS具有相关性(P<0.05),绝经与否(DFS:P=0.060,OS:P=0.031)和化疗方案(DFS:P=0.118,OS:P=0.024)仅与OS具有相关性。多因素分析显示,125Ⅰ粒子、LNR、PR状态仍然是DFS、OS的独立预测指标(P<0.05)。结论 LNR作为一个独立预测指标,可用于评价行保留乳房手术治疗发生淋巴结转移的乳腺癌患者的预后;在LNR≤0.20的患者125Ⅰ粒子术中植入能有效控制乳腺癌术后局部复发,提高了无病生存期率和总生存期率。更多还原

【Abstract】 Objective To discuss clinical value of 125Ⅰ particles intraoperative implantation in therapy of early breastcancer patients. Methods Retrospective analysis of 53 patients with breast cancer surgery treatment and routine clinicalpathological data obtained from Hainan Medical College affiliated hospital from January 2005 to December 2008 wereperformed, disease- free survival(DFS) and overall survival(OS) were compared according to whether the intraoperativeimplantation of125Ⅰ particles or not. Results A total of 39 female cases with early breast cancer were treated with125Ⅰ particlesimplantation and breast conservative surgery. According to the TPS project, into a row of125Ⅰ particles(more than l0) wereimplanted to the side near the sternum line after the medial longitudinal around and within the thoracic artery and implanted125Ⅰ particles(more than l0) at the level of axillary vein to collarbone and regional. Univariate analysis showed that the number of125Ⅰ, LNR, estrogen and progesterone receptor status, and hormone therapy were the prognostic factors for DFS and OS(P<0.05).The correlation between menopause(DFS:P=0.060,OS:P=0.031)and chemotherapy(DFS:P=0.118,OS:P=0.024)was onlyrelated to OS. Multivariate analysis indicated that125Ⅰ, LNR, estrogen and progesterone receptor status were independentprognostic factors of DFS and OS(P<0.05). Conclusion LNR is an independent prognostic factor in axillary lymph node-positive breast cancer patients treated with breast conservation surgery. LNR<0.20, intraoperative implantion of125Ⅰ caneffectively control postoperative local recurrence of breast cancer, and improve the survival rate without disease and overallsurvival rates.更多还原