保乳手术联合放疗对乳腺癌患者血清肿瘤标志物水平及预后的影响
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摘要
目的探讨保乳手术联合放疗对乳腺癌患者血清肿瘤标志物水平及预后的影响。方法回顾性分析98例乳腺癌患者的病历资料,根据治疗方法不同将患者分为研究组和对照组,其中研究组40例患者采用保乳手术治疗,并于术后2～6周后行放射治疗;对照组58例患者采用乳腺癌根治术治疗。比较两组患者治疗前后血清β2-微球蛋白(β2-MG)、癌胚抗原(CEA)、糖类抗原15-3(CA15-3)、糖类抗原125(CA125)、几丁质酶-3样蛋白-1(YKL-40)的水平,并对两组患者的5年生存情况进行比较。结果治疗前,两组患者的血清β2-MG、CEA、CA15-3、CA125、YKL-40水平比较,差异均无统计学意义(P﹤0.05)。治疗后,研究组患者的血清β2-MG、CEA、CA15-3、CA125、YKL-40水平均明显低于对照组(P﹤0.01);治疗后,研究组患者的血清β2-MG、CEA、CA15-3、CA125、YKL-40水平均低于本组治疗前(P﹤0.05)。研究组患者行放疗过程中,放射性皮肤损伤、放射性食管炎、放射性肺炎的发生率较高,分别为100%、30.00%、25.00%;两组患者的远处转移率、局部复发率、5年生存率比较,差异均无统计学意义(P﹥0.05)。结论乳腺癌患者实施保乳手术联合放疗能够降低患者的血清肿瘤标志物水平,达到与乳腺癌根治术相同的治疗效果,但是放疗引起的不良反应应该予以重视。
Objective To investigate the effect of breast-conserving surgery combined with radiotherapy on the levels of serum tumor markers and prognosis in patients with breast cancer. Method The medical records of 98 patients with breast cancer were retrospectively analyzed. Patients were stratified as study group and control group according to the different treatment methods. 40 patients in the study group were treated with breast-conserving surgery, and radiation therapy was performed 2 to 6 weeks after surgery. In addition, 58 patients in the control group were administered with radical mastectomy. The levels of serum β2-microglobulin(β2-MG), carcinoembryonic antigen(CEA), carbohydrate antigen 15-3(CA15-3), carbohydrate antigen 125(CA125), and chitinase-3-like-1 protein(YKL-40) were compared before and after treatment in the two group, and the 5-year survival of the two groups was evaluated. Result Before treatment, the serum levels of serum β2-MG, CEA, CA15-3, CA125 and YKL-40 in the two groups were not significantly different(P<0.05).After treatment, the serum levels of β2-MG, CEA, CA15-3, CA125 and YKL-40 in the study group were significantly lower than those in the control group(P<0.01). After treatment, the serum levels of β2-MG, CEA, CA15-3, CA125 and YKL-40 in the study group were lower than those before treatment(P<0.05). During the radiotherapy of the study group,the incidence rate of radiation injury of skin, radiation esophagitis and radiation pneumonitis were higher(100%, 30.00%and 25.00%, respectively). The distant metastasis rate, local recurrence rate, and the 5-year survival rate were similar between the two groups(P>0.05). Conclusion Breast-conserving surgery combined with radiotherapy can reduce the serum level of tumor markers in patients with breast cancer, and achieving the same effect as radical mastectomy. However,the adverse reaction caused by radiotherapy should be addressed.
Objective To investigate the effect of breast-conserving surgery combined with radiotherapy on the levels of serum tumor markers and prognosis in patients with breast cancer. Method The medical records of 98 patients with breast cancer were retrospectively analyzed. Patients were stratified as study group and control group according to the different treatment methods. 40 patients in the study group were treated with breast-conserving surgery, and radiation therapy was performed 2 to 6 weeks after surgery. In addition, 58 patients in the control group were administered with radical mastectomy. The levels of serum β2-microglobulin(β2-MG), carcinoembryonic antigen(CEA), carbohydrate antigen 15-3(CA15-3), carbohydrate antigen 125(CA125), and chitinase-3-like-1 protein(YKL-40) were compared before and after treatment in the two group, and the 5-year survival of the two groups was evaluated. Result Before treatment, the serum levels of serum β2-MG, CEA, CA15-3, CA125 and YKL-40 in the two groups were not significantly different(P<0.05).After treatment, the serum levels of β2-MG, CEA, CA15-3, CA125 and YKL-40 in the study group were significantly lower than those in the control group(P<0.01). After treatment, the serum levels of β2-MG, CEA, CA15-3, CA125 and YKL-40 in the study group were lower than those before treatment(P<0.05). During the radiotherapy of the study group,the incidence rate of radiation injury of skin, radiation esophagitis and radiation pneumonitis were higher(100%, 30.00%and 25.00%, respectively). The distant metastasis rate, local recurrence rate, and the 5-year survival rate were similar between the two groups(P>0.05). Conclusion Breast-conserving surgery combined with radiotherapy can reduce the serum level of tumor markers in patients with breast cancer, and achieving the same effect as radical mastectomy. However,the adverse reaction caused by radiotherapy should be addressed.
引文
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[6]张倚玮,季丽丽,卢国华.书写表达对乳腺癌患者心理影响的研究进展[J].中华护理杂志, 2016, 51(1):94-97.
[7] Ellis MJ, Ding L, Shen D, et al. Whole-genome analysis informs breast cancer response to aromatase inhibition[J]. Nature, 2012, 486(7403):353-360.
[8]范瑜红,方华英,伍晓慧.紫杉醇联合卡铂在晚期宫颈癌新辅助化疗中的应用研究[J].中国生化药物杂志, 2017,37(4):379-381.
[9] Giordano SH, Buzdar AU, Smith TL, et al. Is breast cancer survival improving? Trends in survival for patients with recurrent breast cancer diagnosed from 1974 through 2000[J].Cancer, 2004, 100(1):44-52.
[10]许晓倩,王健民.β2微球蛋白在恶性血液病中的临床意义[J].中华血液学杂志, 2005, 26(7):444-446.
[11]吴以龙,杨沱.癌胚抗原在不同上消化道疾病组织中的表达及临床意义[J].中国基层医药, 2012, 19(21):3264-3265.
[12]田满福,韩波.检测CA199、CA125、CA15-3及CEA在肿瘤诊断中的意义[J].临床和实验医学杂志, 2010, 9(7):483-485
[13] Johansen JS, Olee T, Price PA, et al. Regulation of YKL-40 production by human articular chondrocytes[J]. Arthritis Rheum, 2001, 44(4):826-837.
[14]张锡贵,李太东,倪武,等.早期乳腺癌保乳手术联合放化疗治疗方案的临床研究[J].中国现代普通外科进展,2015, 18(9):709-711.
[15]张芹.早期乳腺癌保乳术后大分割放疗的研究进展[J].实用肿瘤杂志, 2017, 32(4):296-299.
[2]邢季伟,孟宪璞,邢胜男,等.乳腺癌患者术后恐惧疾病进展的状况及影响因素分析[J].癌症进展, 2018, 16(2):254-257.
[3]曲范杰,时淑珍,佟倩.雄激素受体与三阴性乳腺癌相关性的研究进展[J].肿瘤学杂志, 2018, 24(3):181-187.
[4]邵志敏,李俊杰. 2015版《中国抗癌协会乳腺癌诊治指南与规范》:外科部分解读[J].中华乳腺病杂志(电子版),2016, 10(1):1-5.
[5]皋文君,刘砚燕,袁长蓉,等.国际肿瘤化疗药物不良反应评价系统——通用不良反应术语4.0版[J].肿瘤, 2012, 32(2):142-144.
[6]张倚玮,季丽丽,卢国华.书写表达对乳腺癌患者心理影响的研究进展[J].中华护理杂志, 2016, 51(1):94-97.
[7] Ellis MJ, Ding L, Shen D, et al. Whole-genome analysis informs breast cancer response to aromatase inhibition[J]. Nature, 2012, 486(7403):353-360.
[8]范瑜红,方华英,伍晓慧.紫杉醇联合卡铂在晚期宫颈癌新辅助化疗中的应用研究[J].中国生化药物杂志, 2017,37(4):379-381.
[9] Giordano SH, Buzdar AU, Smith TL, et al. Is breast cancer survival improving? Trends in survival for patients with recurrent breast cancer diagnosed from 1974 through 2000[J].Cancer, 2004, 100(1):44-52.
[10]许晓倩,王健民.β2微球蛋白在恶性血液病中的临床意义[J].中华血液学杂志, 2005, 26(7):444-446.
[11]吴以龙,杨沱.癌胚抗原在不同上消化道疾病组织中的表达及临床意义[J].中国基层医药, 2012, 19(21):3264-3265.
[12]田满福,韩波.检测CA199、CA125、CA15-3及CEA在肿瘤诊断中的意义[J].临床和实验医学杂志, 2010, 9(7):483-485
[13] Johansen JS, Olee T, Price PA, et al. Regulation of YKL-40 production by human articular chondrocytes[J]. Arthritis Rheum, 2001, 44(4):826-837.
[14]张锡贵,李太东,倪武,等.早期乳腺癌保乳手术联合放化疗治疗方案的临床研究[J].中国现代普通外科进展,2015, 18(9):709-711.
[15]张芹.早期乳腺癌保乳术后大分割放疗的研究进展[J].实用肿瘤杂志, 2017, 32(4):296-299.