手术切除联合植入缓释型5-FU在局部区域复发的乳腺癌患者中的应用分析（附27例病例数据分析）

doi:10.3969/j.issn.1009-976X.2021.04.011

摘要/Abstract

摘要： 目的初步分析手术切除联合植入缓释型氟尿嘧啶（5-FU）与非手术治疗对局部区域复发的乳腺癌患者的效果,探讨前者的临床作用及应用前景。方法回顾性入组自2010年01月至2019年12月于江门市中心医院甲乳外科就诊并进行治疗的乳腺癌患者共726例,筛选符合入组条件的局部区域复发（LRR）患者共27例,其中13例选择手术切除联合植入型5-FU,14例非手术治疗,所有患者均接受巩固放疗。比较两组患者的一般资料及预后信息。结果治疗方法的选择与复发年龄,LRR类型、IHC结果等无明显相关（P>0.05）。接受手术治疗联合植入型5-FU的患者较非手术治疗患者显著降低二次局部区域复发风险,其中位LRPFS为28个月,优于非手术组的16个月（χ²=6.38,P=0.012）。是否接受手术治疗并未改善整体预后,两组患者OS差异无统计学意义（P>0.05）。结论针对乳腺癌术后LRR患者,接受积极手术切除病灶同时植入缓释型5-FU,辅以巩固放疗,可有效提高局部病灶控制效果,延长局部无进展生存期,改善生活质量。

关键词: 乳腺癌, 局部区域复发, 手术治疗, 缓释型5-FU

Abstract: Objective To evaluate the usefulness and efficient of the surgical excision combined with Fluorouracil（5-FU） Implants in breast cancer patients with local regional relapse （LRR） by comparing with non-surgical. Methods Totally 726 patients treated as breast cancer from January 2010 to December 2019 in Jiangmen Central Hospital were registered, in which 27 patients with LRR were enrolled. Analysis of the general data and prognosis information of two groups, surgical excision with Fluorouracil Implants and non-surgical. Results The treatment decision has no significant correlation with the relapse age, LRR pattern and result of IHC （P>0.05）. Patients accepted surgical excision with Fluorouracil Implants has the reducing risk of secondary LRR significantly, with a median LRPFS is 28 months, while the median LRPFS of patients without surgery is 16 months （χ²=6.38,P=0.012）. Whether accepting the surgical treatment did not improve overall prognosis, and there was no statistically significant difference OS in both groups （P>0.05）. Conclusion For breast cancer patients with LRR, accepted positive surgical excision of the lesions and combined with 5-FU implants, then supplemented by consolidating radiation therapy, which can effectively reinforce the effect of local lesion control, extend the local progression-free survival and improve the quality of life.

Key words: breast cancer, local regional relapse, surgical excision, fluorouracil implants

中图分类号:

R737.9

关健华, 温坚坤, 林启谋, 黄文俊. 手术切除联合植入缓释型5-FU在局部区域复发的乳腺癌患者中的应用分析（附27例病例数据分析）[J]. 岭南现代临床外科, 2021, 21(04): 428-431.

GUAN Jian-hua, WEN Jian-kun, LIN Qi-mou, HUNAG Wen-jun. A study of surgical excision combined with 5-FU implants in patients with local regional recurrence of breast cancer[J]. Lingnan Modern Clinics In Surgery, 2021, 21(04): 428-431.

参考文献

[1] Sharma R, Rourke LL, Kronowitz SJ, et al.Management of local-regional recurrence following immediate breast reconstruction in patients with early breast cancer treated without postmastectomy radiotherapy[J]. Plast Reconstr Surg, 2011, 127(5):1763-1772.
[2] Jeong Y, Kim SS, Gong G, et al.Prognostic Factors for Distant Metastasis in Patients with Locoregional Recurrence after Mastectomy[J]. J Breast Cancer, 2015,18(3):279-284.
[3] Cardoso F, Harbeck N, Fallowfield L, et al. Locally recurrent or metastatic breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up [J]. Ann Oncol, 2012, 23 (Suppl 7):vii11-19.
[4] Wadasadawala T, Vadgaonkar R, Bajpai J.Management of Isolated Locoregional Recurrences in Breast Cancer: A Review of Local and Systemic Modalities[J]. Clin Breast Cancer, 2017, 17(7):493-502.
[5] Smith JP, Kanekal S, Patawaran MB, et al.Drug retention and distribution after intratumoral chemotherapy with fluorouracil/epinephrine injectable gel in human pancreatic cancer xenografts[J]. Cancer Chemother Pharmacol, 1999, 44(4):267-274.
[6] 周毅,关健华,林启谋,杜春花. 乳腺癌术中植入缓释氟尿嘧啶间质化疗的研究[J]. 南昌大学学报(医学版), 2012, 52(1): 33-35.
[7] Mackey JR, Martin M, Pienkowski T, et al.Adjuvant docetaxel, doxorubicin, and cyclophosphamide in node-positive breast cancer: 10-year follow-up of the phase 3 randomised BCIRG 001 trial[J]. Lancet Oncol, 2013, 14(1):72-80.
[8] Krag DN, Anderson SJ, Julian TB, et al.Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial[J]. Lancet Oncol, 2010, 11(10):927-933.
[9] Katz A, Strom EA, Buchholz TA, et al.Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation[J]. J Clin Oncol, 2000, 18(15):2817-2827.
[10] Hsi RA, Antell A, Schultz DJ, Solin LJ.Radiation therapy for chest wall recurrence of breast cancer after mastectomy in a favorable subgroup of patients[J]. Int J Radiat Oncol Biol Phys, 1998, 42(3):495-499.
[11] Anderson SJ, Wapnir I, Dignam JJ, et al.Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer[J]. J Clin Oncol, 2009, 27(15):2466-2473.
[12] Cowen D, Jacquemier J, Houvenaeghel G, et al.Local and distant recurrence after conservative management of “very low-risk” breast cancer are dependent events: a 10-year follow-up[J]. Int J Radiat Oncol Biol Phys, 1998, 41(4):801-807.
[13] Pisansky TM, Ingle JN, Schaid DJ, et al.Patterns of tumor relapse following mastectomy and adjuvant systemic therapy in patients with axillary lymph node-positive breast cancer. Impact of clinical, histopathologic, and flow cytometric factors[J]. Cancer, 1993, 72(4):1247-1260.
[14] 王岳,孙慧茹,孟祥颖. 乳腺癌根治术后局部区域复发R0切除术后放疗110例分析[J].中华放射医学与防护杂志, 2018,38(9): 670-674.
[15] 徐惠,王承伟,吴立广.替吉奥联合三维适形放疗治疗局部复发乳腺癌临床疗效分析[J].肿瘤基础与临床, 2017, 30(2): 121-123.
[16] Fisher B,Wickerham DL,Deutsch M,et al.Breast tumor recurrence following lumpectomy with and without breast irradia-tion: an overview of recent NSABP findings[J]. Semin Surg Oncol, 1992, 8(3): 153-160.
[17] Aebi s, Gelber S, Anderson SJ, et al. Chemotherapy for isolat-ed locoregional recurrence of breast cancer (CALOR) : a ran-domised trial[J]. Lancet Oncol, 2014, 15(2): 156-163.