中国普外基础与临床杂志

中国普外基础与临床杂志

早期乳腺癌患者的肿瘤位置与淋巴转移的关系

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目的 总结早期乳腺癌中肿瘤位置与淋巴结转移的关系,旨在为乳腺癌患者提供更加个体化的治疗方式。 方法 检索近年来相关文献,通过文献复习,就乳腺癌肿瘤位置与淋巴转移关系的研究进展进行综述。 结果 目前对于乳腺癌肿瘤位置的分类主要有以下 2 种方法:肿瘤所在象限和肿瘤至皮肤距离。在象限分类方法中,肿瘤位于内上象限者(UIQ)的淋巴结转移率最低,而发生在内下象限(LIQ)患者的无复发生存率及总体生存率最低;在测量肿瘤至皮肤距离的方式中,肿瘤距离皮肤越近,越易发生淋巴结转移。结合淋巴管及淋巴管网在分布、组织学及解剖学上的差异,笔者所在团队提出了按照肿瘤位于乳房不同解剖层次进行分类的方法,分为:局限腺体内、向前突破腺体、向后突破腺体者及前后均突破腺体者 4 类。 结论 不论按照何种方式进行位置分类,乳腺癌的肿瘤位置与淋巴结转移均密切相关,按照肿瘤在乳房不同解剖层次分布的新分类方式符合淋巴系统转移的规律,具有合理性及科学性,因此在临床工作中建议使用此方法对肿瘤位置进行分类,并且应当考虑到患者肿瘤位置的差异来评估乳腺癌患者的腋窝淋巴结状态,为乳腺癌患者制定更加个体化的治疗方案。

Objective To summarize the relation between tumor location and lymph node metastasis in early stage of breast cancer, which is aimed at providing a more individualized treatment for breast cancer patients. Methods The literatures about breast cancer location and lymph node metastasis in recent years were extracted, through the literatures study we made a thematic review of the relation between them. Results There were two main classification methods for the location of breast tumors at present: tumor in the different quadrants and tumor to skin distance. In the quadrant classification method, the tumor in the upper inner quadrant (UIQ) had the lowest lymph node metastasis rate, while the lower inner quadrant (LIQ) tumor recurrence-free survival rate and overall survival rate were significantly lower than other quadrants. When measuring tumor to skin distance, the closer the tumor was to the skin, the more likely lymph node metastasis occurred. In combination with the distribution, histology, and anatomical differences of lymphatic and lymphatic networks, our study group proposed to classify tumors according to different anatomical levels of the breast, thus the anatomic location of the tumor was divided into four types: constricted in the gland, break the anterior gland, break the posterior gland, and break both anterior and posterior gland. Conclusion Regardless of the way the location is classified, the location of breast tumors is closely related to lymphatic and lymph node metastasis. The new classification according to the distribution of tumors at different anatomical levels of the breast accords with the law of lymphatic metastasis is scientific and reasonable. Therefore, during clinical practices, we recommend to use the new method to classify tumor location, and we should consider the differences in the location of the patients’tumor to assess the status of axillary lymph node, which may provide a more individualized treatment for breast cancer patients.

关键词: 乳腺癌; 肿瘤位置; 肿瘤解剖层次; 淋巴转移; 综述

Key words: breast cancer; tumor location; tumor anatomy level location; lymphatic metastasis; review

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