Solin L J, Fowble B L, Yeh I T, Kowalyshyn M J, Schultz D J, Weiss M C, Goodman R L
Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia.
Int J Radiat Oncol Biol Phys. 1992;23(5):961-8. doi: 10.1016/0360-3016(92)90900-3.
An analysis was performed of 39 consecutive women with microinvasive ductal carcinoma of the breast treated with breast-conserving surgery and definitive irradiation during the period 1977 to 1988. Microinvasive ductal carcinoma was defined as predominantly intraductal carcinoma with microscopic or early invasion. Surgical treatment of the primary tumor included excisional biopsy or wide resection. Axillary lymph node staging showed that 37 patients were pathologically node negative and two patients were pathologically node positive, each with only one positive lymph node. The median follow-up was 55 months (mean = 65 months; range = 25-135 months). The 5-year actuarial rate of overall and cause-specific survival were both 97%. The 5-year actuarial rate of freedom from distant metastases was 93%. Nine patients developed a recurrence in the breast; eight of the nine patients had isolated local only first failures, and one of the nine patients had a local recurrence simultaneously with distant metastases. The median time to local failure was 42 months (mean = 53 months; range = 20-116 months). Of the eight patients with local only first failure, seven patients have been salvaged with further treatment and remain free of disease at the time of last follow-up, and one patient has died of subsequent distant metastatic disease. Median follow-up after salvage treatment was 29 months (mean = 27 months; range = 0-54 months). Comparison of the patients with microinvasive ductal carcinoma with two control groups of intraductal carcinoma and invasive ductal carcinoma was performed. Although the rate of local failure was significantly higher for patients with microinvasive ductal carcinoma as compared to the two control groups, the rates of survival and freedom from distant metastases for patients with microinvasive ductal carcinoma were intermediate to the two control groups. Because of the high rates of survival and freedom from distant metastases and because of the ability to salvage patients with local recurrence, breast-conserving surgery and definitive irradiation should continue to be considered as an alternative to mastectomy for appropriately selected and staged patients with microinvasive ductal carcinoma of the breast.
对1977年至1988年期间39例接受保乳手术及根治性放疗的乳腺微浸润性导管癌连续病例进行了分析。微浸润性导管癌定义为以导管内癌为主且伴有显微镜下或早期浸润。原发肿瘤的手术治疗包括切除活检或广泛切除。腋窝淋巴结分期显示，37例患者病理检查淋巴结阴性，2例患者病理检查淋巴结阳性，均仅有1个阳性淋巴结。中位随访时间为55个月（平均=65个月；范围=25 - 135个月）。5年总生存率和病因特异性生存率均为97%。5年无远处转移生存率为93%。9例患者乳腺出现复发；9例患者中有8例仅有局部首次复发，9例患者中有1例局部复发同时伴有远处转移。局部复发的中位时间为42个月（平均=53个月；范围=20 - 116个月）。8例仅有局部首次复发的患者中，7例经进一步治疗后病情得到挽救，在最后一次随访时仍无疾病，1例患者死于随后的远处转移性疾病。挽救治疗后的中位随访时间为29个月（平均=27个月；范围=0 - 54个月）。将微浸润性导管癌患者与导管内癌和浸润性导管癌两个对照组进行了比较。尽管微浸润性导管癌患者的局部复发率明显高于两个对照组，但微浸润性导管癌患者的生存率和无远处转移率介于两个对照组之间。由于生存率和无远处转移率较高，且有能力挽救局部复发的患者，对于经适当选择和分期的乳腺微浸润性导管癌患者，保乳手术及根治性放疗应继续被视为乳房切除术的替代方案。
