Molecular Pathologic And Clinical Study On Safe Extension Of Breast Conservative Surgery In Breast Cancer

Breast conservative surgery (BCS) has become one of the most important treatment for clinical stage I and II breast cancer abroad, while it has not been performed popularly in China. With the increasing of early detection, improvement of society civilization and patients' participation in selecting treatment scheme, BCS will be the trend of breast cancer surgery therapy in 21st century in China. Successful BCS will not only decrease local recurrence, but also maintenance good cosmetic result, which requires excising enough paracarcinoma tissue and repairing residual breast. But there is not definite criterion for excision extension in BCS and there are a lot of difference between Chinese women and Western women in breast cancer, such as age, pathologic types, breast size, and so on. Therefore, it is necessary to explore the excision extension for BCS which is suitable for Chinese women.185 cases of BCS (quadrantectomy) in our hospital was analyzed retrospectively to observe the treatment effects and cosmetic results. It was shown that 5-year overall survival rate, disease free survival rate and local recurrence rate were 98.8%, 96.3% and 1.3%, and those of 10-year were 86.4%, 81.8%, 13.6%, respectively, the same as which of mastectomy. But it was not satisfied that there were only 53.8% cases with excellent and good cosmetic result. As a result, it is considered to lessen excision extension nearby primary tumor so as to guarantee cosmetic result.48 cases of negative margin specimen of BCS and 62 specimen of mastectomy were examined using whole specimen section, immunohistochemistry and molecular biology methods to observe pathological changes and expressions of PCNA, P53 and C-erbB-2 in primary tumor and paracarcinoma tissues. And two groups of positive and negative margin cases were compared in order to explore theclinicopathologic factors concerned with positive margin. It was suggested that 2cm nearby primary tumor was safe extension of BCS and the distance of outside margin could be lessened to lcm. It should be enlarged excision extension (>2cm) when there was c-erbB-2 amplification or p53 mutation in primary tumor, and should be reduced excision extension (<2cm)in histologic grade I breast cancer. When primary tumor with extensive intruductal component(EIC), the margins should be examined carefully during operation so as to ensure negative margin, or else, mastectomy should be performed.In a word, it has been shown by both morphology and molecular biology study that risk factors of local recurrence after BCS were mainly(95.2%) existed within 2cm nearby primary tumor in clinical stage I and II breast cancer. So it is recommended that 2cm nearby primary tumor is safe extension for BCS. and it is necessary to choice individual treatment for breast cancer with different clinicopathologic characteristics.