Fuentes Raspall M José, Piedrafita Serra Encarna, Isern Verdum José, Alonso Muñoz Carmen, Ojeda González Belén, Gómez Gómez Antonio, Llauradó Ollé Antonio, Duarte Pires Dalila, Lerma Puertas Enrique, Craven-Bartle Lamote De Grignon Jordi, López López Antonio, Trias Folch Manuel
Oncología Radioterápica. Hospital de la Santa Creu i Sant Pau. Barcelona. Spain.
Med Clin (Barc). 2002 Feb 16;118(5):161-5. doi: 10.1016/s0025-7753(02)72321-x.
Since 1992 conservative treatment of breast cancer (stage I and II: clinical TNM) has been established as an alternative to mastectomy in our hospital. The aim of this retrospective study was to analyse locoregional recurrence features and to compare prognosis with regard to to site of recurrence.
Between 1987 and 1993, 489 patients with breast cancer (stages I and II) were treated with conservative surgery and radiation therapy at the Hospital Sant Pau of Barcelona. Mean follow-up was 58.8 months [between 12-144]. 35 patients developed locoregional recurrence. We considered two groups: local recurrence in breast only; and locoregional recurrence such as nodal recurrence with or without simultaneous breast recurrence. Diagnosis was confirmed by histopathologic analysis. An extensive study was performed in all patients to rule out distant metastasis. Last follow-up was December 1999.
The locoregional recurrence rate after conservative treatment was 7.5% and that of local recurrence was 3.06%. Recurrences were diagnosed in 80% of patients by physical examination, while 20% of patients had noticed the tumor recurrence themselves. Histologic grade III tumors had a higher number of locoregional recurrences than local recurrences (p = 0.030). Locoregional recurrences had lower overall survival rate (p = 0.0005), lower disease-free survival rate (p = 0.0012) and shorter time period without distant metastasis (p < 0.0005) than local recurrences.
Most recurrences were diagnosed by clinical examination during follow up. Histologic grade III was related to locoregional recurrences. Local recurrences had a better prognosis than locoregional recurrences.
自1992年以来，我院已确立乳腺癌（I期和II期：临床TNM）的保守治疗作为乳房切除术的替代方案。这项回顾性研究的目的是分析局部区域复发特征，并比较不同复发部位的预后情况。
1987年至1993年间，巴塞罗那圣保禄医院对489例I期和II期乳腺癌患者进行了保守手术和放射治疗。平均随访时间为58.8个月[12 - 144个月]。35例患者出现局部区域复发。我们将其分为两组：仅乳房局部复发；以及局部区域复发，如伴有或不伴有同时发生的乳房复发的淋巴结复发。通过组织病理学分析确诊。对所有患者进行了广泛检查以排除远处转移。最后一次随访时间为1999年12月。
保守治疗后的局部区域复发率为7.5%，局部复发率为3.06%。80%的患者通过体格检查诊断出复发，而20%的患者自己注意到了肿瘤复发。组织学III级肿瘤的局部区域复发次数多于局部复发次数（p = 0.030）。与局部复发相比，局部区域复发的总生存率较低（p = 0.0005），无病生存率较低（p = 0.0012），无远处转移的时间较短（p < 0.0005）。
大多数复发是在随访期间通过临床检查诊断出来的。组织学III级与局部区域复发有关。局部复发的预后比局部区域复发更好。
