影响保乳手术切缘状态的临床病理因素多因素分析

发布时间：2018-03-26 05:01

  本文选题：保乳手术　切入点：切缘状态　出处：《广西医科大学》2017年硕士论文

【摘要】：目的:保乳治疗已成为早期乳腺癌的标准治疗方式之一。保证手术切缘阴性可显著降低局部复发,当切缘阳性时往往需要再次手术达到充分切缘,再次手术延长了手术时间、增加住院费用及病人痛苦。本研究目的是评估病人、肿瘤及诊疗因素与首次切除切缘阳性率的关联,为乳腺癌保乳手术决策提供帮助。材料和方法:本研究共纳入312例于2012年8月至2016年8月于广西医科大学第一附属医院行保乳手术的早期乳腺癌病人,采用SPSS19.0软件行卡方检验及二元逻辑回归分析如下因素与切缘阳性的关联:患者年龄、绝经状态、乳腺密度、有无术前MRI检查、微小钙化、蟹足肿样外观、活检方式、活检与保乳手术时间间隔、肿瘤的ER、PR、Ki-67、HER-2、P16、P53表达情况,有无DCIS成分、脉管淋巴浸润(LVI)、组织学分级、肿瘤大小、淋巴结状态、肿瘤方位、切缘取材方式及手术方式。结果:本研究纳入的312个病例中共有55例切缘阳性,阳性率17.6%。在单因素分析中,如下因素与切缘阳性率相关联:Ki-67(P=0.021)、LVI(P=0.048)、有无导管内癌成分(P=0.012)及手术方式(P=0.004)。在多因素分析中:高ki-67表达(OR=0.398,95%CI(0.204-0.777))及保乳整形手术(OR=0.650,95%CI(0.452-0.933))是切缘阳性的保护因素。结论:肿瘤相关因素与诊疗方式与切缘阳性率有关,肿瘤组织的ki-67低表达、LVI、含DCIS成分会增加保乳手术首次切缘阳性率,而实施保乳整形手术可以降低首次切缘阳性率。
[Abstract]:Objective: breast conserving therapy has become one of the standard treatment methods for early breast cancer. To ensure the negative margin of operation can significantly reduce the local recurrence, when the incision margin is positive, it is often necessary to reoperate to the full margin, and the reoperation prolongs the operation time. The purpose of this study was to evaluate the association between the patient, tumor, diagnosis and treatment factors and the positive rate of the first excision margin. Materials and methods: 312 breast cancer patients who underwent breast conserving surgery in the first affiliated Hospital of Guangxi Medical University from August 2012 to August 2016 were enrolled in this study. SPSS19.0 software was used to perform chi-square test and binary logistic regression analysis. The following factors were associated with positive margin: age, menopausal status, breast density, MRI examination before operation, microcalcification, appearance of crab foot swelling, and biopsy method. The time interval between biopsy and breast conserving surgery, the expression of P16 p53, DCIS, histological grade, tumor size, lymph node status, tumor location, tumor size, lymph node status, tumor location, and the presence of DCIS. Results: 55 of 312 cases in this study were positive for cutting edge, the positive rate was 17.6%. The following factors were associated with the positive rate of incision margin: 1 Ki-67 PnP 0.021 LVII Pu 0.048 (with or without intraductal carcinoma P0. 012) and surgical procedure P0. 004. In the multivariate analysis: high expression of ki-67 was 0.3988 ~ 95CII 0.204-0.777) and OR0.650 / 95CI0.452-0.933) were protective factors. Conclusion: tumor related factors are: tumor related factors. It is related to the diagnosis and treatment mode and the positive rate of cutting edge. The low expression of ki-67 in tumor tissues may increase the positive rate of the first cut edge of breast conserving surgery, but the positive rate of the first cut edge can be reduced by breast conserving plastic surgery.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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