Heaton K M, Peoples G E, Singletary S E, Feig B W, Ross M I, Ames F C, Buchholz T A, Strom E A, McNeese M D, Hunt K K
Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Ann Surg Oncol. 1999 Jan-Feb;6(1):102-8. doi: 10.1007/s10434-999-0102-8.
The optimal management of contralateral breast cancer (CC) in patients previously treated with breast-conserving therapy (BCT) is unclear, as is whether these patients continue to choose BCT as the preferred treatment of their second breast cancer.
Of 1328 patients treated with BCT at The University of Texas M. D. Anderson Cancer Center between 1958 and 1994, 63 developed a contralateral breast cancer. We reviewed the charts of these patients retrospectively, and standard demographic and treatment variables were evaluated. Survival was analyzed by the Kaplan-Meier method and subgroups by chi2 analysis.
Twenty-nine percent of the patients had a family history of breast cancer. First breast cancers were detected by patient or physician in 67% of cases and by mammogram in 17% of cases, compared to 59% and 36%, respectively, of CC (P = .04). Median time to development of CC was 61 months. Sixty percent of the initial tumors were AJCC stage 0 or I with a median size of 2 cm, whereas 74% of the CC were stage 0 or I (P = .02), with a median size of 1.5 cm. Eighty-seven percent of patients chose BCT for treatment of CC. There were few treatment-related complications. Recurrence rates were not significantly different from those of patients undergoing BCT for the initial cancer (P = .47), and 5- and 10-year actuarial survival rates after the first cancer were 93% and 76%, respectively. Median follow-up was 134 and 56 months from the time of diagnosis of the initial cancer and CC, respectively.
Because contralateral breast cancer often is detected at an early stage, there are few treatment-related complications, and the risk of recurrence is no different from that for the initial cancer, BCT is an acceptable and desirable option for appropriately selected patients with metachronous or synchronous bilateral breast cancers.
对于先前接受保乳治疗（BCT）的患者，对侧乳腺癌（CC）的最佳管理尚不清楚，这些患者是否继续选择BCT作为其第二原发性乳腺癌的首选治疗方法也不明确。
1958年至1994年间在德克萨斯大学MD安德森癌症中心接受BCT治疗的1328例患者中，63例发生了对侧乳腺癌。我们回顾性地查阅了这些患者的病历，并评估了标准的人口统计学和治疗变量。采用Kaplan-Meier法分析生存率，采用卡方分析对亚组进行分析。
29%的患者有乳腺癌家族史。67%的首次乳腺癌是由患者或医生发现的，17%是通过乳房X线摄影发现的，相比之下，对侧乳腺癌分别为59%和36%（P = 0.04）。发生对侧乳腺癌的中位时间为61个月。60%的初始肿瘤为美国癌症联合委员会（AJCC）0期或I期，中位大小为2 cm，而74%的对侧乳腺癌为0期或I期（P = 0.02），中位大小为1.5 cm。87%的患者选择BCT治疗对侧乳腺癌。很少有与治疗相关的并发症。复发率与接受BCT治疗原发性癌症的患者相比无显著差异（P = 0.47），首次癌症后的5年和10年精算生存率分别为93%和76%。从初始癌症和对侧乳腺癌诊断时间起，中位随访时间分别为134个月和56个月。
由于对侧乳腺癌通常在早期被发现，很少有与治疗相关的并发症，且复发风险与原发性癌症无异，因此对于适当选择的异时性或同时性双侧乳腺癌患者，BCT是一种可接受且理想的选择。
