Vicini F A, Eberlein T J, Connolly J L, Recht A, Abner A, Schnitt S J, Silen W, Harris J R
Department of Radiation Therapy, Harvard Medical School, Boston, Massachusetts.
Ann Surg. 1991 Sep;214(3):200-4; discussion 204-5. doi: 10.1097/00000658-199109000-00002.
The optimal extent of breast resection before irradiation for treatment of early breast cancer has not been defined. Increasing the size of the resection may decrease the risk of local recurrence but will also have an adverse impact on the cosmetic outcome. The 5-year likelihood of a recurrence of the tumor was analyzed in relation to the volume of resected breast tissue in 507 patients with infiltrating ductal carcinoma treated with conservative surgery and radiation therapy between 1968 and 1982. Patients were stratified by clinical T-stage and for each T-stage patients were divided into three groups of equal numbers based on the volume of excised tissue. All patients had at least a gross excision of the tumor and the extent of breast resection was determined at the discretion of the surgeon without knowledge of the histologic features of the tumor. The median follow-up time was 100 months. The 5-year actuarial recurrence rates were analyzed in relation to clinical T-stage (T1 or T2) and the presence or absence of an extensive intraductal component (EIC+ or EIC-). For patients with EIC+ tumors, the largest resections were associated with a substantially lower risk of recurrence in the breast than the smallest resections. This effect was seen both for T1 tumors (10% versus 29%, p = 0.07) and for T2 tumors (9% versus 36%, p = 0.04). For patients with EIC-tumors, recurrence rates were significantly lower than for EIC+ tumors and were not influenced by the volume of resection to the same degree as EIC+ tumors. In the absence of an EIC, recurrence rates for the largest and smallest resections were 0% and 9% (p = 0.02) for T1 tumors and 3% and 6% (p = NS) for T2 tumors. It is concluded that a limited breast resection is acceptable for an EIC- tumor but that a more extensive resection is required for an EIC+ tumor. These results stress the importance of assessing the presence or absence of an EIC in determining the optimal extent of breast resection required before radiation therapy.
早期乳腺癌放疗前乳房切除的最佳范围尚未明确。扩大切除范围可能会降低局部复发风险，但也会对美容效果产生不利影响。分析了1968年至1982年间接受保乳手术和放射治疗的507例浸润性导管癌患者肿瘤复发的5年可能性与切除乳房组织体积的关系。患者按临床T分期分层，对于每个T分期，根据切除组织的体积将患者分为三组，每组人数相等。所有患者至少对肿瘤进行了大体切除，乳房切除范围由外科医生自行决定，且外科医生不了解肿瘤的组织学特征。中位随访时间为100个月。分析了5年精算复发率与临床T分期（T1或T2）以及是否存在广泛导管内成分（EIC+或EIC-）的关系。对于EIC+肿瘤患者，最大范围的切除与乳房复发风险显著低于最小范围切除相关。这种效应在T1肿瘤（10%对29%，p = 0.07）和T2肿瘤（9%对36%，p = 0.04）中均可见。对于EIC-肿瘤患者，复发率显著低于EIC+肿瘤患者，且与EIC+肿瘤患者不同，切除范围对其影响程度较小。在不存在EIC的情况下，T1肿瘤最大和最小切除范围的复发率分别为0%和9%（p = 0.02），T2肿瘤分别为3%和6%（p = 无显著性差异）。结论是，对于EIC-肿瘤，有限的乳房切除是可以接受的，但对于EIC+肿瘤，则需要更广泛的切除。这些结果强调了在确定放疗前所需乳房切除的最佳范围时评估是否存在EIC的重要性。
