Kini V R, Vicini F A, Frazier R, Victor S J, Wimbish K, Martinez A A
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
Int J Radiat Oncol Biol Phys. 1999 Jan 15;43(2):341-6. doi: 10.1016/s0360-3016(98)00395-2.
We retrospectively reviewed our institution's experience treating early-stage breast cancer patients with breast conserving therapy (BCT) to determine clinical, pathologic, mammographic, and treatment-related factors associated with outcome.
Between January 1980 and December 1987, 400 cases of Stage I and II breast cancer were managed with BCT at William Beaumont Hospital, Royal Oak, Michigan. All patients underwent at least an excisional biopsy. Radiation treatment consisted of delivering 45-50 Gy to the whole breast, followed by a boost to the tumor bed to at least 60 Gy in all patients. The median follow-up in the 292 surviving patients is 118 months. Multiple clinical, pathologic, mammographic, and treatment-related factors were analyzed for an association with local recurrence and survival.
A total of 37 local recurrences developed in the treated breast, for a 5- and 10-year actuarial rate of 4% and 10%, respectively. On univariate analysis, patient age < or =35 years (25% vs. 7%, p = 0.004), and positive surgical margins (17% vs. 6%, p = 0.018) were associated with an increased risk of local recurrence at 10 years. On multivariate analysis, only age < or = 35 years remained significant. A subset analysis of 214 patients with evaluable mammographic findings was performed. On univariate analysis, age < or = 35 years (38% vs. 8%, p = 0.0029) and the presence of calcifications on preoperative mammography (22% vs. 6%, p = 0.0016) were associated with an increased risk of local recurrence. On multivariate analysis, both of these factors remained significant. The presence of calcifications on preoperative mammography did not affect the rates of overall survival, disease-free survival, and cause-specific survival.
In patients with early-stage breast cancer treated with BCT, age < or = 35 years and calcifications on preoperative mammography appear to be associated with an increased risk of local recurrence.
我们回顾性分析了本机构采用保乳治疗（BCT）早期乳腺癌患者的经验，以确定与预后相关的临床、病理、乳腺X线摄影及治疗相关因素。
1980年1月至1987年12月期间，密歇根州皇家橡树市威廉·博蒙特医院对400例I期和II期乳腺癌患者采用了保乳治疗。所有患者均至少接受了切除活检。放射治疗包括对全乳给予45 - 50 Gy照射，随后对所有患者的瘤床追加照射至至少60 Gy。292例存活患者的中位随访时间为118个月。分析了多个临床、病理、乳腺X线摄影及治疗相关因素与局部复发和生存的相关性。
治疗的乳房共发生37例局部复发，5年和10年精算复发率分别为4%和10%。单因素分析显示，年龄≤35岁（25%对7%，p = 0.004）以及手术切缘阳性（17%对6%，p = 0.018）与10年局部复发风险增加相关。多因素分析显示，只有年龄≤35岁仍具有显著性。对214例有可评估乳腺X线摄影结果的患者进行了亚组分析。单因素分析显示，年龄≤35岁（38%对8%，p = 0.0029）以及术前乳腺X线摄影存在钙化（22%对6%，p = 0.0016）与局部复发风险增加相关。多因素分析显示，这两个因素均仍具有显著性。术前乳腺X线摄影存在钙化不影响总生存、无病生存及病因特异性生存的发生率。
在接受保乳治疗的早期乳腺癌患者中，年龄≤35岁以及术前乳腺X线摄影存在钙化似乎与局部复发风险增加相关。
