Chism Derek B, Freedman Gary M, Li Tianyu, Anderson Penny R
Department of Radiation Oncology, North Shore Medical Center, Peabody, MA, USA.
Int J Radiat Oncol Biol Phys. 2006 Aug 1;65(5):1416-21. doi: 10.1016/j.ijrobp.2006.02.017. Epub 2006 May 26.
To identify factors in breast cancer patients that predict the pathologic results of re-excision for close or positive margins and to determine the effect on local control.
We divided 1,044 patients with Stage I-II breast cancer with a close (< or =2 mm) or positive margin after initial excision into three groups. Group 1 included 199 patients without additional excision, Group 2 included 546 patients with re-excision found to be free of cancer, and Group 3 included 299 patients with re-excision and residual cancer. All patients were treated with radiotherapy with a median follow-up of 6.7 years.
The 10-year local control rate was 95% for Group 1 and 94% for Groups 2 and 3 (p = 0.788). Of the 846 patients, 65% had no residual disease on re-excision and 35% did have residual tumor. The factors significantly associated with positive re-excision findings were initial positive margins, positive nodes, Stage T2 tumor, and an extensive intraductal component. The 10-year local control rate was 95% for Group 2 vs. 91% for Group 3 (p = 0.038).
The low recurrence rates seen in this study suggest that selected patients with non-negative margins, particularly those with a low risk of having residual disease at re-excision, may be treated with radiotherapy.
确定乳腺癌患者中能够预测切缘接近或阳性时再次切除的病理结果的因素，并确定其对局部控制的影响。
我们将1044例I-II期乳腺癌患者分为三组，这些患者在初次切除后切缘接近（≤2mm）或阳性。第一组包括199例未进行额外切除的患者，第二组包括546例再次切除后未发现癌症的患者，第三组包括299例再次切除后仍有残留癌的患者。所有患者均接受放射治疗，中位随访时间为6.7年。
第一组的10年局部控制率为95%，第二组和第三组为94%（p = 0.788）。在846例患者中，65%再次切除时无残留疾病，35%确实有残留肿瘤。与再次切除阳性结果显著相关的因素包括初次切缘阳性、淋巴结阳性、T2期肿瘤和广泛的导管内成分。第二组的10年局部控制率为95%，第三组为91%（p = 0.038）。
本研究中观察到的低复发率表明，部分切缘非阴性的患者，尤其是那些再次切除时残留疾病风险较低的患者，可能可以接受放射治疗。
