Downey R J, Rusch V, Hsu F I, Leon L, Venkatraman E, Linehan D, Bains M, van Zee K, Korst R, Ginsberg R
Divisions of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Thorac Cardiovasc Surg. 2000 Mar;119(3):420-8. doi: 10.1016/s0022-5223(00)70119-x.
The effectiveness of chest wall resection for locally recurrent breast cancer as cancer treatment remains poorly defined, possibly because of the general impression that locally recurrent disease is a harbinger of rapidly progressive metastatic disease and that extensive surgical treatment in these patients is inappropriate. Reports to date have focused on technical feasibility, not long-term outcome.
We reviewed our experience with 38 women who underwent chest wall resection for locally recurrent breast cancer between October 1987 and May 1997. Overall survival was calculated by the Kaplan-Meier method and the significance of prognostic variables evaluated by log-rank and Cox regression analyses.
The operative mortality rate was 0%. Overall survival at 1, 3, and 5 years after chest wall resection was 74%, 41%, and 18%, respectively, and the proportion of patients free of local recurrence at 1, 3, and 5 years was 59%, 42%, and 13%, respectively. Regional nodal disease and size of largest tumor nodule (>4 cm) were significant predictors of local re-recurrence (P <.01, P =.04); lymph node metastasis was the only predictor of long-term survival (P <.01). Patients with and without synchronous sites of metastatic disease had near-identical 3-year survivals.
Chest wall resection for locally recurrent breast cancer has a low mortality. However, a significant number of patients have the development of local re-recurrence or metastases, and 5-year survival is limited. It is unlikely that complete resection of all locally recurrent disease improves survival. Future studies should focus on the quality of palliation achieved.
胸壁切除术作为局部复发性乳腺癌的癌症治疗方法，其有效性仍未明确界定，这可能是因为人们普遍认为局部复发性疾病是快速进展性转移性疾病的先兆，且对这些患者进行广泛的手术治疗并不合适。迄今为止的报告都集中在技术可行性上，而非长期疗效。
我们回顾了1987年10月至1997年5月间38例接受胸壁切除术治疗局部复发性乳腺癌的女性患者的经验。采用Kaplan-Meier法计算总生存率，并通过对数秩检验和Cox回归分析评估预后变量的显著性。
手术死亡率为0%。胸壁切除术后1年、3年和5年的总生存率分别为74%、41%和18%，1年、3年和5年无局部复发的患者比例分别为59%、42%和13%。区域淋巴结疾病和最大肿瘤结节大小（>4 cm）是局部再次复发的显著预测因素（P<.01，P=.04）；淋巴结转移是长期生存的唯一预测因素（P<.01）。有和无同步转移部位的患者3年生存率几乎相同。
局部复发性乳腺癌的胸壁切除术死亡率较低。然而，相当数量的患者会出现局部再次复发或转移，5年生存率有限。完全切除所有局部复发性疾病不太可能提高生存率。未来的研究应关注所实现的姑息治疗质量。
