Smitt Melanie C, Nowels Kent, Carlson Robert W, Jeffrey Stefanie S
Department of Radiation Oncology, Stanford University, Stanford, CA, USA.
Int J Radiat Oncol Biol Phys. 2003 Nov 15;57(4):979-85. doi: 10.1016/s0360-3016(03)00740-5.
To identify predictors of reexcision findings and local recurrence in the setting of breast-conserving therapy with radiation.
The records of 535 patients who underwent breast-conserving surgery followed by radiation for Stage I or II cancer between 1972 and 1996 were reviewed. The mean follow-up period for surviving patients without evidence of recurrence is 6 years. Various clinical and pathologic prognostic factors were examined for significance with regard to reexcision findings and recurrence rates. Pathologic margin status was classified as negative, close (<or=2 mm), positive, or indeterminate.
The pathologic margin status was the most important predictor of local recurrence. The freedom from local relapse (FFLR) at 6 years was 97% for patients with negative pathologic margins and 86% for all others (p < 0.0001). There was no significant difference in recurrence rates among patients with close, positive, or indeterminate margins. However, the use and sequencing of systemic therapy affected recurrence rates among these patients. For patients with close, positive, or indeterminate margins, the crude risk of local recurrence was 4% among patients who received tamoxifen or received chemotherapy integrated with or after radiation. The risk of local recurrence was 16-29% among the patients with close, positive, or indeterminate margins who did not receive systemic therapy or who received radiation after completion of chemotherapy. Local recurrence rates were low in patients with negative margins (2-8%) regardless of the use of systemic therapy or its timing. The presence or absence of residual disease at reexcision did not predict recurrence as long as the final margins were negative. Among patients who underwent reexcision before radiation, extensive intraductal component (EIC) (p = 0.0001) and young patient age (p = 0.03) were predictive of residual disease in the specimen. Patients with initially close margins and no EIC had a low risk of residual disease at the time of reexcision, as did patients older than age 65 without EIC.
Pathologic margin status is the most important predictor of local recurrence after breast conservation with radiation. Patient age and EIC were significant predictors of residual disease at reexcision. The use and timing of systemic therapy appear to influence the risk of local recurrence in patients who do not have negative lumpectomy margins.
确定在保乳放疗治疗背景下再次切除结果及局部复发的预测因素。
回顾了1972年至1996年间535例行保乳手术并随后接受I期或II期癌症放疗患者的记录。无复发证据的存活患者平均随访期为6年。检查了各种临床和病理预后因素对再次切除结果和复发率的意义。病理切缘状态分为阴性、切缘接近（≤2mm）、阳性或不确定。
病理切缘状态是局部复发的最重要预测因素。病理切缘阴性患者6年无局部复发率（FFLR）为97%，其他所有患者为86%（p<0.0001）。切缘接近、阳性或不确定的患者复发率无显著差异。然而，全身治疗的使用和顺序影响这些患者的复发率。对于切缘接近、阳性或不确定的患者，接受他莫昔芬或接受放疗联合或放疗后化疗的患者局部复发的粗风险为4%。未接受全身治疗或化疗完成后接受放疗的切缘接近、阳性或不确定的患者局部复发风险为16 - 29%。切缘阴性患者的局部复发率较低（2 - 8%），无论是否使用全身治疗或其时间安排。只要最终切缘为阴性，再次切除时是否存在残留疾病并不能预测复发。在放疗前接受再次切除的患者中，广泛导管内成分（EIC）（p = 0.0001）和年轻患者年龄（p = 0.03）可预测标本中的残留疾病。最初切缘接近且无EIC的患者以及65岁以上无EIC的患者再次切除时残留疾病风险较低。
病理切缘状态是保乳放疗后局部复发的最重要预测因素。患者年龄和EIC是再次切除时残留疾病的重要预测因素。全身治疗的使用和时间似乎会影响保乳手术切缘非阴性患者的局部复发风险。
