Nielsen Hanne M, Overgaard Marie, Grau Cai, Jensen Anni R, Overgaard Jens
Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
Radiother Oncol. 2006 May;79(2):147-55. doi: 10.1016/j.radonc.2006.04.006. Epub 2006 Apr 27.
In the DBCG 82 b&c trials, 3,083 patients with stages II and III breast cancer were randomised to receive post-mastectomy radiotherapy (RT) versus no RT in addition to systemic therapy. The study showed a decrease in loco-regional recurrences and an improved survival in patients receiving RT. The aim of the present study was to identify risk factors for loco-regional recurrence (LRR), to evaluate the treatment of LRR and to examine the prognosis after LRR.
The 18-year probabilities of LRR were calculated for different prognostic factors using the Kaplan-Meier method. The efficacy of different LRR treatments was compared. The 5-year survival and distant metastases (DM) probability after LRR was calculated with regard to initial randomization group, primary tumor and recurrence related variables.
Of the 3,083 patients, 535 had a LRR alone as first site of failure. In univariate analyses, large primary tumor size, ductal carcinoma, high malignancy grade, fascia invasion, few removed nodes, many positive nodes and extracapsular invasion were all risk factors for developing LRR. Combined treatment with surgery and RT at the time of LRR increased the persistent loco-regional control. The 5-year probability of subsequent DM was 73% irrespective of initial randomization group. In multivariate analysis, large primary tumor size, many positive nodes, extracapsular invasion, supra/infraclaviculary failures, multiple LRR and a short interval less than 2 years to first LRR were poor prognostic factors for survival.
Twenty-seven percent of LRR patients had no DM 5 years after failure. Initial randomization group did not alter the prognosis after LRR. Combined treatment of the LRR with surgery and RT improved persistent loco-regional control compared with surgery or RT alone.
在丹麦乳腺癌协作组82 b&c试验中，3083例II期和III期乳腺癌患者被随机分组，在接受全身治疗的基础上，一组接受乳房切除术后放疗（RT），另一组不接受放疗。研究表明，接受放疗的患者局部区域复发减少，生存率提高。本研究的目的是确定局部区域复发（LRR）的危险因素，评估LRR的治疗方法，并研究LRR后的预后情况。
采用Kaplan-Meier法计算不同预后因素的18年LRR概率。比较不同LRR治疗方法的疗效。根据初始随机分组、原发肿瘤和复发相关变量，计算LRR后的5年生存率和远处转移（DM）概率。
3083例患者中，535例单独出现LRR作为首个失败部位。在单因素分析中，原发肿瘤体积大、导管癌、恶性程度高、筋膜侵犯、切除淋巴结少、阳性淋巴结多和包膜外侵犯均为发生LRR的危险因素。LRR时联合手术和放疗可提高局部区域的持续控制率。无论初始随机分组如何，随后发生DM的5年概率均为73%。在多因素分析中，原发肿瘤体积大、阳性淋巴结多、包膜外侵犯、锁骨上/下失败、多发LRR以及首次LRR间隔小于2年是生存的不良预后因素。
27%的LRR患者在失败后5年无DM。初始随机分组不影响LRR后的预后。与单纯手术或放疗相比，LRR联合手术和放疗可提高局部区域的持续控制率。
