Haffty Bruce G, Hauser Analene, Choi Doo Ho, Parisot Nicole, Rimm David, King Bonnie, Carter Darryl
Department of Therapeutic Radiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8040, USA.
Cancer. 2004 Jan 15;100(2):252-63. doi: 10.1002/cncr.11915.
Local chest wall recurrence after mastectomy occurs in 10-20% of patients with operable breast carcinoma. The objective of the current study was to assess the prognostic value of molecular markers at the time of local recurrence and to compare these markers with clinical variables.
Between 1975 and 1999, the authors treated 113 patients at their institution for postmastectomy chest wall recurrences with full-course external beam radiotherapy. Patients who presented primarily with lymph node recurrences or with simultaneous distant metastasis were excluded. Follow-up from the time of chest wall recurrence was 10.13 years. All clinical and pathologic data from the original diagnosis and from the time of chest wall recurrence were entered into a computerized database. Paraffin-embedded tumor specimens from the chest wall recurrences were available for 43 patients and were constructed into tissue microarrays for immunohistochemical staining of estrogen receptor, progesterone receptor (PR), p53, HER-2/neu, and cyclin D.
Overall survival after chest wall recurrence for the entire cohort was 46% at 5 years and 28% at 10 years. The distant metastasis-free survival rate was 49% at 5 years and 40% at 10 years. Local-regional control of disease was achieved in 79% of patients at 10 years. In multivariate analysis, significant factors for distant metastasis after local recurrence were time to recurrence (< 2 years from the original diagnosis to chest wall recurrence) and PR status (distant metastasis-free survival rate: 84% [PR-positive] vs. 38% [PR-negative]; P = 0.007). The only significant factor for local-regional disease progression was HER-2/neu status. Patients with positive HER-2/neu status had a local-regional progression-free rate of 59%, compared with 92% for patients with negative HER-2/neu status.
The prognosis for patients after local-regional recurrence of breast carcinoma is relatively poor. Longer time to local recurrence and positive PR status were associated with favorable distant metastasis-free rates and long-term survival. Positive HER-2/neu status was associated with poorer local-regional control of disease. Implications for systemic therapy and further studies are discussed.
乳房切除术后局部胸壁复发发生在10% - 20%的可手术乳腺癌患者中。本研究的目的是评估局部复发时分子标志物的预后价值，并将这些标志物与临床变量进行比较。
1975年至1999年间，作者所在机构对113例乳房切除术后胸壁复发患者进行了全程外照射放疗。主要表现为淋巴结复发或同时伴有远处转移的患者被排除。从胸壁复发时开始随访，时间为10.13年。将来自初始诊断和胸壁复发时的所有临床和病理数据录入计算机数据库。43例患者有胸壁复发的石蜡包埋肿瘤标本，制成组织芯片用于雌激素受体、孕激素受体（PR）、p53、HER-2/neu和细胞周期蛋白D的免疫组化染色。
整个队列胸壁复发后的总生存率在5年时为46%，10年时为28%。无远处转移生存率在5年时为49%，10年时为40%。10年时79%的患者实现了疾病的局部区域控制。在多变量分析中，局部复发后远处转移的显著因素是复发时间（从初始诊断到胸壁复发<2年）和PR状态（无远处转移生存率：PR阳性为84%，PR阴性为38%；P = 0.007）。局部区域疾病进展的唯一显著因素是HER-2/neu状态。HER-2/neu状态阳性的患者局部区域无进展率为59%，而HER-2/neu状态阴性的患者为92%。
乳腺癌局部区域复发后患者的预后相对较差。局部复发时间较长和PR状态阳性与良好的无远处转移率和长期生存相关。HER-2/neu状态阳性与疾病的局部区域控制较差相关。讨论了对全身治疗的意义及进一步研究。
