早期乳腺癌的局部治疗策略目前已经从‘最大的可耐受治疗”转变为”最小的有效的治疗“。保乳手术是欧美国家早期乳腺癌的主流术式选择，亚洲日韩等国家保乳治疗比例也较高，我国大型医院保乳手术所占比例正在不断增加。近年随着肿瘤整形技术的提高和患者对美容需求的增加，世界范围内乳腺癌整形手术的比例明显增多，我国目前部分大型医院开展的也相当不错。而两种不同术式的优缺点及对预后的影响尚存争议，近年这部分内容在St.Gallen和SABCS会议上被热议，如何选取理想的术式、不同术式对生存和美容带来不同的影响等问题尚未达成共识。

　　在今年即将召开的EBCC大会3月10日poster外科局部治疗板块将发表一篇报道（Comparison of 350 consecutive oncoplastic procedures to 350 conventional breast conserving therapies. Oncological， cosmetic and quality of life outcomes），针对乳腺肿瘤整形手术和保乳手术进行了比较，分析对肿瘤预后、美容和生活质量（QoL）的影响。该报道入组了2008-2014年350例接受乳腺癌整形手术的患者，根据临床病理学特征和保乳手术进行对比，QoL分析采用EORTC-QLQ-BR23调查，美容评估主要以患者满意度评估为主。结果显示肿瘤整形手术不影响后续辅助治疗，对生存预后没有影响，并最大限度减少了再次切除。

　　对医生和乳腺癌患者来说，这是一个非常有意义的研究，将为医生和患者对乳腺癌术式选择决策提供依据，可能对临床实践产生影响，让我们共同期待。

　　张建国 教授

　　哈尔滨医科大学附二院乳腺外科主任，主任医师、教授

　　中华预防医学会妇女保健分会乳腺组委员

　　中国医师协会乳腺专家培训专家委员会常务委员

　　中国医师协会外科医师分会乳腺外科医师委员会常务委员

　　中国医药协会乳腺疾病专业委员会副主任委员

　　中国抗癌协会乳腺癌专业委员会委员

　　黑龙江省抗癌协会乳腺癌专业委员会副主任委员

　　Annals of Surgery 中文版乳腺专刊编委；中华乳腺病杂志编委

研究摘要

Comparison of 350 consecutive oncoplastic procedures to 350 conventional breast conserving therapies. Oncological， cosmetic and quality of life outcomes

P. Kelemen， D. Pukancsik， M. Ujhelyi， E. Kovacs， N. Udvarhelyi， I. Kenessey， M. Kasler， Z. Matrai

Background: Oncoplastic breast surgery (OPS) is a rapidly evolving， progressive surgical intervention in the treatment of early breast cancers. Progressive surgical strategies， combined with a variety of individualized， aesthetic approaches qualify OPS as a recommended surgical treatment. OPS benefits BCS patients by allowing a maximized resection volume with extended tumor-free margins， resulting in no delay of adjuvant therapy. OPS yields optimized cosmesis， elevated patient satisfaction and enhanced quality of life. Authors conducted this comparison to offer a progressive study of OPS cases， considering oncologic outcomes， complications， patient satisfaction， and to corroborate advantages via the results of a retrospective assessment of conventional BCS meta-datasets.

Material and Methods: 350 patients were enrolled in the study， all of whom received OPS， performed by qualified breast surgeons from 2008–2014. A prospectively maintained clinico-pathological database was evaluated and compared with a retrospective assessment of 350， randomized BCS cases. When measuring QoL， the EORTC-QLQ-BR23 survey was distributed. Cosmetics was scored in a patient-assessed 10-point scale.

Results: Increased surgical duration， more quadrantectomy， larger excised specimens， extended negative margins， and fewer completion surgeries were recorded in OPS. No difference in time to adjuvant therapy， or complications were summarized. Statistical analytics of QLQ surveys expressed a significant superiority of OPS. This was reinforced by higher cosmetic rates.

Conclusion: OPS provides oncologic risk reduction by not delaying adjuvant therapies. Furthermore， the removal of large tumors with wider margins make true quadrantectomy possible. OPS yields fewer re-exscisions， although surgical duration is prolonged. To reassure disease-free survival， longer follow up is required.