65例三阴乳腺癌的临床病理特点及诊治分析

发布时间：2018-12-15 07:52

【摘要】：目的：揭示三阴乳腺癌(TNBC)患者的临床病理特征,探讨提高患者术后无复发生存期(DFS)和总生存时间(0S)的策略。方法：回顾性分析广西医科大学第一附属医院胃肠腺体外科2010年1月至2014年1月之间65例TNBC患者的临床资料、治疗方法,病理特点及预后。结果：本组65例TNBC占同期我院乳腺癌的12.7%(65/512),患者年龄25～70岁,平均46.3岁,肿瘤最大径1.0～7.0 cm,平均3.5cm。腋窝淋巴结转移率43.1%(28/65)。其中浸润性导管癌54例(83.1%),导管内癌3例(4.6%),其他类型8例(12.3%),包括化生性癌2例,髓样癌1例,乳头状癌4例,透明细胞癌1例。组织学分级：I级2例(3.1%),II级44例(67.7%),Ⅲ级19例(29.2%)。临床分期(TNM)：I期15.4%(10/65),II期56.9%(37/65),Ⅲ期27.7%(18/65)。行乳腺癌改良根治术45例,保乳手术12例,全乳切除术加腋窝前哨淋巴结活检术(SLNB)8例。接受全身化疗62例,其中铂类与紫杉醇类联合方案新辅助化疗占14.5%(9/62),以葸环类为主或与紫杉类联合方案辅助化疗占82.3%(51/62),予FEC联合辅助化疗占3.2%(2/62)。术后随访12月～40月,平均随访22.7个月,术后胸壁复发3例,对侧乳腺复发1例,行复发灶或对侧乳腺再切除术和二线化疗。术后肺转移2例,肝转移1例,骨、脑等多发脏器转移4例。均予二线化疗控制病情。因乳腺癌死亡4例。结论：TNBC肿瘤较大,腋窝淋巴结转移率高,临床分期晚,以浸润性导管癌多见,Ki-67蛋白质高表达,是侵袭性强的恶性肿瘤。TNBC患者的腋窝淋巴结转移、病理组织类型与预后有显著相关性。TNBC术后远处脏器转移几率高,且发生时间早,预后差。化疗是唯一可选择的全身辅助治疗方案,进一步增加TNBC患者接受新辅助化疗的比例,通过提高新辅助化疗的pCR,是提高TNBC治疗水平的希望。
[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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