Thurman Sarah A, Schnitt Stuart J, Connolly James L, Gelman Rebecca, Silver Barbara, Harris Jay R, Recht Abram
Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Int J Radiat Oncol Biol Phys. 2004 May 1;59(1):152-9. doi: 10.1016/j.ijrobp.2003.10.029.
To evaluate the site of first failure of patients with early-stage tubular, mucinous, and medullary breast carcinoma after breast-conserving therapy and compare their results with those of patients with infiltrating ductal carcinoma (IDC).
Twenty clinical Stage I and II patients with mucinous carcinoma, 27 with medullary carcinoma, 28 with tubular carcinoma, and 1055 with IDC were identified. The minimal potential follow-up was 10 years.
No statistically significant difference (p = 0.15) was seen in the site of first failure between the four histologic types within the first 10 years after treatment. When the IDC tumors were omitted from the comparison, the failure patterns of the remaining three histologic types were not significantly different (p = 0.31). In a polychotomous logistic model, histologic type was not significantly associated with the site of first failure (all p >0.17). Local failure was significantly associated with age <50 years (p = 0.04), positive surgical margins (p = 0.007), lymphovascular invasion (p = 0.04), and tumors with an extensive intraductal component (p <0.001). Regional/distant/opposite breast failure was significantly associated with clinical Stage T2 tumors (p <0.001), four or more positive lymph nodes (p = 0.004), and lymphovascular invasion-positive tumors (p <0.001). Second malignancy or death was significantly associated with age at diagnosis >60 years (p <0.001) and lymphovascular invasion-positive tumors (p = 0.03).
No statistically significant difference was noted in the site of first failure between patients with medullary, mucinous, or tubular carcinoma and patients with IDC. Although not statistically significant, we did note a trend toward a lower long-term rate of disease-free survival in patients with IDC.
评估早期管状、黏液性和髓样乳腺癌患者保乳治疗后的首次失败部位,并将其结果与浸润性导管癌(IDC)患者的结果进行比较。
确定了20例临床I期和II期黏液癌患者、27例髓样癌患者、28例管状癌患者和1055例IDC患者。最小潜在随访时间为10年。
在治疗后的前10年内,四种组织学类型之间的首次失败部位无统计学显著差异(p = 0.15)。当IDC肿瘤被排除在比较之外时,其余三种组织学类型的失败模式无显著差异(p = 0.31)。在多分类逻辑模型中,组织学类型与首次失败部位无显著关联(所有p>0.17)。局部失败与年龄<50岁(p = 0.04)、手术切缘阳性(p = 0.007)、淋巴管浸润(p = 0.04)以及具有广泛导管内成分的肿瘤(p<0.001)显著相关。区域/远处/对侧乳腺失败与临床T2期肿瘤(p<0.001)、四个或更多阳性淋巴结(p = 0.004)以及淋巴管浸润阳性肿瘤(p<0.001)显著相关。第二原发恶性肿瘤或死亡与诊断时年龄>60岁(p<0.001)和淋巴管浸润阳性肿瘤(p = 0.03)显著相关。
髓样癌、黏液癌或管状癌患者与IDC患者的首次失败部位无统计学显著差异。尽管无统计学显著差异,但我们确实注意到IDC患者的长期无病生存率有降低的趋势。