摘要目的 探讨妊娠期乳腺癌的诊治经验.方法 回顾性分析2012年1月至2017年7月复旦大学附属妇产科医院收治的17例妊娠期乳腺癌患者的病例资料.患者年龄25～45岁,中位年龄32岁.0期原位癌2例,Ⅱa期1例,Ⅱb期7例,Ⅲa期1例,Ⅲc期2例,Ⅳ期4例.结果 13例患者于妊娠期接受乳腺癌根治手术,手术时孕周为(27.7±4.6)周,其中2例原位癌行单纯乳房切除术,其余11例行乳腺癌改良根治术;先期接受手术治疗的4例患者未使用任何预防措施,2例患者术后24 h内出现频繁宫缩,后续9例患者予以口服硝苯地平预防宫缩,术后未发生明显宫缩.7例患者于妊娠期接受化疗,其中4例三阴型乳腺癌的化疗方案为紫杉醇周疗序贯表柔比星+环磷酰胺,另外3例患者为多西他赛序贯表柔比星+环磷酰胺.15例患者剖宫产终止妊娠,2例自然分娩,分娩孕周为(36.9±1.3)周.其中<35周终止妊娠1例,胎儿娩出后因"新生儿呼吸窘迫综合征"转新生儿ICU,且有先天性听力障碍;其余新生儿体重、身高、智力发育等均良好.17例患者接受4～27个月的随访,中位随访时间为10个月.0～Ⅲc期13例患者中1例术后12个月确诊骨转移,其余12例患者病情无进展,无进展生存率为12/13,总体生存率为13/13.Ⅳ期4例患者中,1例在产后7个月死亡,1例在产后8个月出现肝脏新发转移灶,其余2例患者目前病情稳定.结论 妊娠期乳腺癌可以进行有效治疗,一旦怀疑妊娠期乳腺癌,应积极通过多学科合作详细评估母胎个体化风险和收益.妊娠期化疗对于母胎是安全的,但尚需大样本临床研究和长期随访.新生儿结局与孕周有关,在治疗期间尽可能避免早产.

abstractsObjective To investigate the principles of diagnosis and treatment of breast cancer during pregnancy. Methods Clinical data of patients with breast cancer during pregnancy admitted to Obstetrics and Gynecology Hospital of Fudan University between January 2012 to July 2017 were analyzed retrospectively. A total of 17 patients were diagnosed with breast cancer in pregnancy, the median age was 32 years ( range from 25 to 45 years old) , pathological staging revealed 2 patient with stage 0, 1 with stageⅡa, 7 with stage Ⅱb, 1 with stage Ⅲa, 2 with stage Ⅲc, 4 with stage Ⅳ. Results Thirteen patients received surgical treatment in pregnancy, the gestational age at surgery was (27. 7±4. 6) weeks;2 patients with ductal carcinoma in situ received mastectomy, 11 patients with breast cancer underwent modified radical mastectomy. In patients undergoing surgery during pregnancy, no prophylactic contractions were used in 4 patients who had been treated earlier, there were 2 patients with frequent contractions within 24 hours after operation in these patients. Follow-up 9 patients were given oral nifedipine to prevent contractions, no obvious contractions occurred after the operation. Seven patients received chemotherapy during pregnancy;the chemotherapy of 4 cases of triple negative breast cancer was weekly paclitaxel sequential epirubicin and cyclophosphamide, the chemotherapy of the other three patients was docetaxel sequential epirubicin and cyclophosphamide. Fifteen patients underwent cesarean section to terminate pregnancy, 2 patients underwent spontaneous labor. The gestational age of birth was (36. 9 ±1. 3) weeks. Less than 35 weeks of termination of pregnancy occurred in one patient, the fetus was delivered to the neonatal intensive care unit due to neonatal respiratory distress syndrome, and suffered from congenital dysaudia. The prognosis of the other 16 survived infants was good. The median follow-up time was 10 months ( range from 4 to 27) months, in 13 patients of stage 0 to Ⅲc, one patient were diagnosed with bone metastasis at 12 months after surgery, the remaining 12 patients had no disease progression, the progression free survival rate was 12/13, the overall survival rate was 13/13. Among the 4 patients with stage Ⅳ, one died in 7 months after delivery, one had new liver metastasis in 8 months after delivery. The remaining 2 patients were in stable condition. Conclusions Breast cancer in pregnancy can be treated effectively, multidisciplinary cooperation and detailed assessment of maternal-fetal risks and benefits are necessary. Chemotherapy during pregnancy is safe for maternal-fetal, but it needed a large sample of clinical studies and long-term follow-up. The neonatal outcome was associated with gestational age, and therefore premature delivery was avoided as much as possible during treatment.