Hussien M, Lioe T F, Finnegan J, Spence R A J
Breast Surgery Unit, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, UK.
Breast. 2003 Feb;12(1):23-35. doi: 10.1016/s0960-9776(02)00182-0.
The management and outcome of 131 women with infiltrating lobular carcinoma treated in the Belfast City Hospital between October 1987 and February 1999 were reviewed. Two patients had primary hormonal treatment and were excluded from the statistical analysis, and 129 patients were followed up. Fifty-four patients (41%) had initial breast conservation surgery, which was followed by re-excision of margins in eight patients (14.8%) and completion total mastectomy in 26 patients (48.1%). The breast conservation surgery group, 28 patients (21.7%), was compared with the total mastectomy group, 101 patients (78.2%), after a median follow-up period of 90 months (range 24-160 months). The overall survival was 68.7%. Survival analysis was performed using Kaplan-Meier and Cox regression which showed that lymph node involvement and tumour grade were the only variables affecting survival (P<0.0001, and 0.01, respectively). The type of surgery performed did not affect survival (P=0.42). The total number of patients who developed local recurrence was 17 patients (13.1%, 12 patients in the breast conservation surgery group and five patients in the total mastectomy group, P<0.0001). Kaplan-Meier analysis of local recurrence showed that the type of surgery (P<0.0001), patient age (P=0.02), tumour grade (P=0.002), adjuvant radiotherapy (P=0.013), chemotherapy (P=0.031) and hormonal treatment (P=0.003) significantly affected local recurrence. Cox regression analysis showed that the only factor significantly affecting local recurrence was the type of surgery performed (P=0.02). Patients who underwent mastectomy had less local recurrence than those who had breast conservation surgery. Local recurrence after breast conservation surgery is high, even with clear surgical margins and post-operative radiotherapy. The authors believe that total mastectomy for infiltrating lobular carcinoma is a safer option to control local disease, especially in younger patients and those with high-grade tumours. Overall survival is not affected by the type of surgical treatment. Local recurrence can be a late event and a long-term follow-up is recommended.
对1987年10月至1999年2月间在贝尔法斯特市医院接受治疗的131例浸润性小叶癌女性患者的治疗情况及预后进行了回顾。2例患者接受了初始激素治疗，被排除在统计分析之外，共对129例患者进行了随访。54例患者（41%）最初接受了保乳手术，其中8例患者（14.8%）随后进行了切缘再切除，26例患者（48.1%）进行了全乳切除术。在中位随访期90个月（范围24 - 160个月）后，将保乳手术组的28例患者（21.7%）与全乳切除术组的101例患者（78.2%）进行比较。总体生存率为68.7%。采用Kaplan - Meier法和Cox回归进行生存分析，结果显示淋巴结受累情况和肿瘤分级是影响生存的仅有的变量（分别为P<0.0001和0.01）。所施行的手术类型不影响生存（P = 0.42）。发生局部复发的患者总数为17例（13.1%），其中保乳手术组12例，全乳切除术组5例（P<0.0001）。对局部复发进行的Kaplan - Meier分析表明，手术类型（P<0.0001）、患者年龄（P = 0.02）、肿瘤分级（P = 0.002）、辅助放疗（P = 0.013）、化疗（P = 0.031）及激素治疗（P = 0.003）均对局部复发有显著影响。Cox回归分析显示，显著影响局部复发的唯一因素是所施行的手术类型（P = 0.02）。接受全乳切除术的患者局部复发少于接受保乳手术的患者。即使手术切缘阴性且术后进行放疗，但保乳手术后的局部复发率仍较高。作者认为，对于浸润性小叶癌，全乳切除术是控制局部疾病的更安全选择，尤其是对于年轻患者和高分级肿瘤患者。总体生存不受手术治疗类型的影响。局部复发可能是晚期事件，建议进行长期随访。
