Arriagada R, Lê M G, Contesso G, Guinebretière J M, Rochard F, Spielmann M
Institut Gustave-Roussy (IGR), Villejuif, France.
Ann Oncol. 2002 Sep;13(9):1404-13. doi: 10.1093/annonc/mdf227.
Analyses of predictive factors for local recurrences are important, as an increasing number of patients with early breast cancer opt for a breast-conserving procedure. This study investigates whether factors predictive of local recurrence differ between patients treated with conservative or radical surgery.
Two thousands and six patients with invasive breast carcinoma (< or =25 mm) were included. Of these patients, 717 were treated conservatively (lumpectomy and breast irradiation) and 1289 were treated with total mastectomy. All patients had axillary dissection and received lymph node irradiation if axillary nodes were positive. Most patients did not receive adjuvant chemotherapy or additive hormonal treatments. The mean duration of follow-up was 20 years. The main end point was the total local recurrence rate. The risk factors of local recurrence were estimated by multivariate analyses and interaction tests were used for intergroup comparisons.
Statistically significant predictive factors for mastectomized patients were histological grade, extensive axillary node involvement (10 nodes or more), and inner quadrant tumors, which were of borderline significance. Young age, however, was not a prognostic indicator for local recurrence. The main statistically significant factor for patients treated with a conservative approach was young age (< or =40 years). These younger patients had a five-fold increased risk of developing a breast recurrence compared with patients older than 60 years.
Younger patients with early breast cancer treated with breast-conserving surgery should in particular be followed up at regular intervals so that any sign of local failure can be diagnosed early.
随着越来越多的早期乳腺癌患者选择保乳手术，分析局部复发的预测因素具有重要意义。本研究调查了接受保守手术或根治性手术的患者中，局部复发的预测因素是否存在差异。
纳入2006例浸润性乳腺癌（≤25mm）患者。其中，717例接受保守治疗（乳房肿块切除术和乳房放疗），1289例接受全乳房切除术。所有患者均行腋窝淋巴结清扫，若腋窝淋巴结阳性则接受淋巴结放疗。大多数患者未接受辅助化疗或辅助激素治疗。平均随访时间为20年。主要终点是局部复发总率。通过多因素分析估计局部复发的危险因素，并采用交互作用检验进行组间比较。
对于接受乳房切除术的患者，具有统计学意义的预测因素是组织学分级、广泛腋窝淋巴结受累（10个或更多淋巴结）和内象限肿瘤，后者具有临界意义。然而，年轻并非局部复发的预后指标。对于接受保守治疗的患者，主要的统计学显著因素是年轻（≤40岁）。与60岁以上的患者相比，这些年轻患者发生乳房复发的风险增加了五倍。
接受保乳手术治疗的早期乳腺癌年轻患者尤其应定期随访，以便能早期诊断任何局部复发的迹象。
