Moran Meena S, Haffty Bruce G
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520-8040, USA.
Breast J. 2002 Mar-Apr;8(2):81-7. doi: 10.1046/j.1524-4741.2002.08202.x.
The purpose of this study was to determine the outcome of breast cancer patients sustaining local-regional failure as their first site of relapse in an effort to group patients into prognostic categories. Between January 1970 and December 1992, over 4,000 patients with breast cancer were treated at our facilities with mastectomy or conservative surgery with radiation therapy (CS + RT). Two hundred thirteen patients sustained local-regional relapse without evidence of distant metastasis as their first site of failure, and they served as the population base for this study. The 213 patients with local-regional recurrence of disease were distributed as follows: 68 patients relapsed in the ipsilateral breast following CS + RT within 5 years of original diagnosis (EARLYBR). Fifty-one patients relapsed in the ipsilateral breast after 5 years from original diagnosis (LATEBR). Thirty-five patients relapsed in the chest wall within 5 years following mastectomy (EARLCW). Eighteen patients relapsed in the chest wall later than 5 years following mastectomy, and 41 patients failed in the regional lymphatics following mastectomy or CS + RT (REGREC). Patients with breast relapses were generally treated with salvage mastectomy, and patients with chest wall or regional nodal relapses were treated with radiation to the chest wall, regional nodes, or both. Systemic therapy at the time of local-regional relapse was highly individualized, ranging from observation to tamoxifen to high-dose chemotherapy with transplantation. With a median follow-up of 14 years, the overall 10-year survival for all 213 patients was 61%, and the 10-year distant metastasis-free rate was 59%. Patients with a LATEBR had a relatively favorable prognosis with a 5-year postrelapse distant metastasis rate of 80%. Patients with EARLYBR and LATECW had a similar prognosis, with a 5-year postrelapse distant metastasis rate of 61% and 65%, respectively. Patients with an EARLCW had a 5-year distant recurrence-free rate following a local relapse of 42%. Ten-year survivals from original diagnosis were 62% and 50%, respectively, and distant metastasis-free survival rates were 56% and 52%, respectively. Patients suffering REGREC following mastectomy or CS + RT carried a poor prognosis with a 10-year survival of 33% and a 10-year distant metastasis-free rate of 30%. Patients sustaining local-regional relapse as a first site of failure may be divided into prognostic groups. Patients with LATEBR have a relatively favorable prognosis. Patients with EARLYBR and CWREC have a poorer prognosis with a distant metastatic rate of approximately 50% within 5 years of local-regional relapse. Patients with REGREC have the poorest prognosis. Placing patients with breast cancer and local-regional relapse into these prognostic categories may be helpful in decision making regarding the role of systemic therapy at the time of local-regional relapse.
本研究的目的是确定乳腺癌患者以局部区域复发作为首次复发部位的预后情况，以便将患者分为不同的预后类别。1970年1月至1992年12月期间，超过4000例乳腺癌患者在我们的机构接受了乳房切除术或保乳手术联合放射治疗（CS + RT）。213例患者以局部区域复发作为首个失败部位，且无远处转移证据，他们作为本研究的人群基础。213例疾病局部区域复发的患者分布如下：68例患者在初次诊断后5年内接受CS + RT后同侧乳房复发（EARLYBR）。51例患者在初次诊断5年后同侧乳房复发（LATEBR）。35例患者在乳房切除术后5年内胸壁复发（EARLCW）。18例患者在乳房切除术后5年以后胸壁复发，41例患者在乳房切除术或CS + RT后区域淋巴结复发（REGREC）。乳房复发的患者一般接受挽救性乳房切除术，胸壁或区域淋巴结复发的患者接受胸壁、区域淋巴结或两者的放射治疗。局部区域复发时的全身治疗高度个体化，范围从观察到他莫昔芬治疗，再到高剂量化疗联合移植。中位随访14年，所有213例患者的总体10年生存率为61%，10年无远处转移率为59%。LATEBR患者预后相对较好，复发后5年远处转移率为80%。EARLYBR和LATECW患者预后相似，复发后5年远处转移率分别为61%和65%。EARLCW患者局部复发后5年无远处复发率为42%。初次诊断后的10年生存率分别为62%和50%，无远处转移生存率分别为56%和52%。乳房切除术或CS + RT后发生REGREC的患者预后较差，10年生存率为33%，10年无远处转移率为30%。以局部区域复发作为首个失败部位的患者可分为不同的预后组。LATEBR患者预后相对较好。EARLYBR和CWREC患者预后较差，局部区域复发后5年内远处转移率约为50%。REGREC患者预后最差。将乳腺癌局部区域复发患者归入这些预后类别可能有助于在局部区域复发时制定关于全身治疗作用的决策。
