[早期浸润性乳腺癌的保乳治疗：局部复发挽救治疗后生存的预后因素]

[Breast-conservation treatment for early invasive breast cancer: prognostic factors for survival after salvage treatment of local recurrence].

作者信息

Fodor János

机构信息

Országos Onkológiai Intézet, Sugárterápiás Osztály, Budapest.

出版信息

Magy Onkol. 2007;51(2):127-31. Epub 2007 Jul 29.

PMID:17660868

Abstract

The aim of the study was to investigate prognosis of patients who develop an isolated local recurrence (ILR) after conservative surgery (CS) for early-stage invasive breast cancer. Between 1983 and 1987, 415 patients with stage I-II breast cancer were treated with CS. Of these patients, 68 developed an ILR. The mean follow-up time after ILR was 167 months. Cox models taking potential prognostic factors into account were used to estimate the risk of death. On univariate analysis, age (< or =40 vs. >40 years) at first treatment, time to ILR (< or =24 vs. >24 months), type of recurrence (true vs. new primary tumor, NP), and extent of recurrence (operable vs. inoperable) were, but initial tumor stage (pT1 vs. pT2), initial lymph node stage (pN-negative vs. -positive), adjuvant radiotherapy (yes vs. no), type of salvage surgery (wide excision vs. mastectomy), and recurrent tumor grade (1-2 vs. 3) were not significant predictors of post-recurrence survival. On multivariate analysis only time to ILR proved independent predictor of survival (relative risk: 3.2; 95% confidence interval: 1.4-7.3; p = 0.0051), and the age of the patients showed borderline significance (p = 0.0659). The 15-year actuarial rate of cause-specific survival after ILR was 58% for all patients, 60% and 0% for patients with operable or inoperable recurrence, 30% and 71% for patients with age < or =40 or >40 years, 25% and 72% for patients with time to ILR < or =24 or >24 months, 54% and 88% for patients with true recurrence or NP, and 92% for patients with age >40 years with NP, respectively. The rate of second local recurrence after salvage mastectomy or repeated wide excision was 16% and 28%, respectively (p = 0.2265). As a conclusion, many patients with ILR have good prognosis, particularly those with operable recurrence with prolonged time to ILR, or with NP. Salvage mastectomy is not mandatory for all CS patients.

摘要

本研究的目的是调查早期浸润性乳腺癌保乳手术（CS）后发生孤立性局部复发（ILR）患者的预后情况。1983年至1987年间，415例I-II期乳腺癌患者接受了保乳手术。其中，68例发生了ILR。ILR后的平均随访时间为167个月。采用考虑潜在预后因素的Cox模型来估计死亡风险。单因素分析显示，初次治疗时的年龄（≤40岁与＞40岁）、至ILR的时间（≤24个月与＞24个月）、复发类型（真性复发与新发原发性肿瘤，NP）以及复发范围（可手术与不可手术）是有意义的，但初始肿瘤分期（pT1与pT2）、初始淋巴结分期（pN阴性与阳性）、辅助放疗（是与否）、挽救性手术类型（广泛切除与乳房切除术）以及复发肿瘤分级（1-2级与3级）不是复发后生存的显著预测因素。多因素分析显示，仅至ILR的时间被证明是生存的独立预测因素（相对风险：3.2；95%置信区间：1.4-7.3；p = 0.0051），患者年龄显示出临界显著性（p = 0.0659）。所有患者ILR后15年的病因特异性生存率为58%，可手术或不可手术复发患者分别为60%和0%，年龄≤40岁或＞40岁患者分别为30%和71%，至ILR时间≤24个月或＞24个月患者分别为25%和72%，真性复发或NP患者分别为54%和88%，年龄＞40岁的NP患者为92%。挽救性乳房切除术后或重复广泛切除术后的二次局部复发率分别为16%和28%（p = 0.2265）。总之，许多ILR患者预后良好，尤其是那些复发可手术且至ILR时间延长或为NP的患者。并非所有保乳手术患者都必须进行挽救性乳房切除术。