Fodor J, Sulyok Z, Polgár C, Major T, Tóth J, Németh G
Országos Onkológiai Intézet Sugárterápiás Osztály, 1122 Budapest, Ráth György u. 7-9.
Magy Seb. 2001 Aug;54(4):209-14.
Infiltrating lobular cancer is biologically different from invasive ductal cancer and there is disagreement regarding appropriate local management of this disease.
To examine treatment outcomes after breast-saving surgery for patients with invasive lobular breast cancer.
Between 1983 and 1987, 77 women with early, stage I-II invasive lobular breast cancer were treated with complete gross excision of the tumour and axillary dissection. Fifty-eight of these patients were treated with 50 Gy ipsilateral breast irradiation, and 19 did not receive radiotherapy. During 176 month median follow-up local-regional recurrences, distant metastases, contralateral breast cancers, breast cancer deaths and deaths caused by other disease were scored. The probability of survival was estimated by Kaplan-Meier method. In uni- and multivariate analysis the Cox-model was used. Relative risk (RR) and associated confidence intervals (CI) were calculated from the regression coefficients. Statistical differences in proportions and means were assessed by log rank and Fisher exact-tests.
In the saved breast, the actual rate of local recurrence at 15 years was 13% for irradiated and 53% for non-irradiated patients (RR: 0.1; 95% CI: 0.03-0.31; p: < 0.0001). The incidence of total breast cancer relapses (local-regional recurrences and distant metastases) was also higher for non-irradiated than for irradiated patients (74% vs. 40%; p: 0.0168). In multivariate analysis irradiation (no vs. yes) showed a significant effect on local tumour control (RR: 0.08: 95% CI: 0.02-0.28; p: 0.0001), but menopausal (pre vs. post), T-(T1 vs. T2) and N-(N0 vs. N1) status did not. The breast cancer specific survival at 15 years was 74% without and 62% with local recurrence (RR: 1.45; 95% CI: 0.53-3.96; p: 0.4697). The majority of local recurrences (9 of 14) were curable by salvage surgery. For all patients the rate of contralateral breast cancer was 6.5%.
Results of long-term follow-up confirmed that breast-conserving surgery and radiotherapy is a reasonable treatment for patients with early invasive lobular breast cancer. The majority of local recurrences are curable by salvage surgery.
浸润性小叶癌在生物学特性上与浸润性导管癌不同，对于该疾病的合适局部治疗方法存在分歧。
研究保乳手术后浸润性小叶乳腺癌患者的治疗效果。
1983年至1987年间，77例I-II期早期浸润性小叶乳腺癌女性患者接受了肿瘤完整切除及腋窝清扫术。其中58例患者接受了同侧乳房50 Gy的放疗，19例未接受放疗。在176个月的中位随访期内，对局部区域复发、远处转移、对侧乳腺癌、乳腺癌死亡及其他疾病导致的死亡情况进行评分。采用Kaplan-Meier法估计生存率。单因素和多因素分析采用Cox模型。根据回归系数计算相对危险度（RR）及相关置信区间（CI）。通过对数秩检验和Fisher精确检验评估比例和均值的统计学差异。
在保留的乳房中，放疗患者15年时的实际局部复发率为13%，未放疗患者为53%（RR：0.1；95%CI：0.03-0.31；p：<0.0001）。未放疗患者的乳腺癌总复发率（局部区域复发和远处转移）也高于放疗患者（74%对40%；p：-0.0168）。多因素分析显示，放疗（未放疗对放疗）对局部肿瘤控制有显著影响（RR：0.08；95%CI：0.02-0.28；p：0.---01），但绝经状态（绝经前对绝经后）、T分期（T1对T2）和N分期（N0对N1）无影响。15年时无局部复发的乳腺癌特异性生存率为74%，有局部复发的为共2%（RR：1.45；95%CI：0.53-3.96；p：0.4697）。大多数局部复发（14例中的9例）可通过挽救性手术治愈。所有患者的对侧乳腺癌发生率为6.5%。
长期随访结果证实，保乳手术及放疗是早期浸润性小叶乳腺癌患者的合理治疗方法。大多数局部复发可通过挽救性手术治愈。
