Huang Eugene, Buchholz Thomas A, Meric Funda, Krishnamurthy Savitri, Mirza Nadeem Q, Ames Frederick C, Feig Barry W, Kuerer Henry M, Ross Merrick I, Singletary S Eva, McNeese Marsha D, Strom Eric A, Hunt Kelly K
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2002 Nov 15;95(10):2059-67. doi: 10.1002/cncr.10952.
To distinguish true local recurrences (TR) from new primary tumors (NP) and to assess whether this distinction has prognostic value in patients who develop ipsilateral breast tumor recurrences (IBTR) after breast-conserving surgery and radiotherapy.
Between 1970 and 1994, 1339 patients underwent breast-conserving surgery at The University of Texas M. D. Anderson Cancer Center for ductal carcinoma in situ or invasive carcinoma. Of these patients, 139 (10.4%) had an IBTR as the first site of failure. For the 126 patients with clinical data available for retrospective review, we classified the IBTR as a TR if it was located within 3 cm of the primary tumor bed and was of the same histologic subtype. All other IBTRs were designated NP.
Of the 126 patients, 48 (38%) patients were classified as NP and 78 (62%) as TR. Mean time to disease recurrence was 7.3 years for NP versus 5.6 years for TR (P = 0.0669). The patients with NP had improved 10-year rates of overall survival (NP 77% vs. TR 46%, P = 0.0002), cause-specific survival (NP 83% vs. TR 49%, P = 0.0001), and distant disease-free survival (NP 77% vs. TR 26%, P < 0.0001). Patients with NP more often developed contralateral breast carcinoma (10-year rate: NP 29% vs. TR 8%, P = 0.0043), but were less likely to develop a second local recurrence after salvage treatment of the first IBTR (NP 2% vs. TR 18%, P = 0.008).
Patients with NP had significantly better survival rates than those with TR, but were more likely to develop contralateral breast carcinoma. Distinguishing new breast carcinomas from local disease recurrences may have importance in therapeutic decisions and chemoprevention strategies. This is because patients with new carcinomas had significantly lower rates of metastasis than those with local disease recurrence, but were more likely to develop contralateral breast carcinomas.
区分真正的局部复发（TR）与新发原发性肿瘤（NP），并评估这种区分对于保乳手术和放疗后发生同侧乳腺肿瘤复发（IBTR）的患者是否具有预后价值。
1970年至1994年间，1339例患者在德克萨斯大学MD安德森癌症中心接受了保乳手术，治疗原位导管癌或浸润性癌。其中，139例（10.4%）患者以IBTR作为首个复发部位。对于126例有临床资料可供回顾性分析的患者，如果IBTR位于原发肿瘤床3厘米范围内且组织学亚型相同，我们将其归类为TR。所有其他IBTR均指定为NP。
126例患者中，48例（38%）患者被归类为NP，78例（62%）为TR。NP患者疾病复发的平均时间为7.3年，而TR患者为5.6年（P = 0.0669）。NP患者的10年总生存率（NP为77%，TR为46%，P = 0.0002）、特定病因生存率（NP为83%，TR为49%，P = 0.0001）和远处无病生存率（NP为77%，TR为26%，P < 0.0001）均有所提高。NP患者更常发生对侧乳腺癌（10年发生率：NP为29%，TR为8%，P = 0.0043），但首次IBTR挽救治疗后发生第二次局部复发的可能性较小（NP为2%，TR为18%，P = 0.008）。
NP患者的生存率显著高于TR患者，但更易发生对侧乳腺癌。区分新发乳腺癌与局部疾病复发对于治疗决策和化学预防策略可能具有重要意义。这是因为新发癌患者的转移率明显低于局部疾病复发患者，但更易发生对侧乳腺癌。
