Lukens J Nicholas, Vapiwala Neha, Hwang Wei-Ting, Solin Lawrence J
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA.
Int J Radiat Oncol Biol Phys. 2009 Apr 1;73(5):1475-81. doi: 10.1016/j.ijrobp.2008.06.1955. Epub 2008 Nov 10.
To report the long-term outcomes for women presenting with regional lymph node recurrence after breast conservation treatment with radiotherapy for Stage I and II invasive breast carcinoma.
Of the women with pathologic Stage I and II invasive breast carcinoma treated with breast conservation treatment at the University of Pennsylvania, 29 developed regional nodal recurrence as their first site of failure. An analysis of the patterns of regional nodal recurrence and their prognosis after recurrence was undertaken. The median follow-up from regional nodal recurrence was 5.4 years.
The pattern of regional nodal recurrence was as follows: 14 (48%) with simultaneous local and axillary recurrence, 7 (24%) with recurrence in the axilla only, 5 (17%) with recurrence in the supraclavicular region only, and 3 (10%) with multiple nodal sites of recurrence. For the entire study group, the 5-, 10-, and 15-year overall survival rate was 70%, 37%, and 28%, respectively. The 10-year overall survival rate for patients with locoregional recurrence was 32% compared with 45% for patients with regional-only recurrence (p = 0.50). The 10-year overall survival rate for patients with axillary recurrence discovered on pathologic examination of the mastectomy specimen was 31% compared with 42% for patients with palpable regional lymphadenopathy (p = 0.83).
Patients with regional nodal recurrence after breast conservation treatment with radiotherapy for early-stage breast carcinoma are potentially salvageable. The prognosis after regional nodal recurrence was not significantly different when stratified by the presence or absence of simultaneous in-breast recurrence or the method of detection.
报告Ⅰ期和Ⅱ期浸润性乳腺癌保乳治疗并放疗后出现区域淋巴结复发的女性患者的长期预后情况。
在宾夕法尼亚大学接受保乳治疗的Ⅰ期和Ⅱ期病理确诊的浸润性乳腺癌女性患者中，29例出现区域淋巴结复发，为首次复发部位。对区域淋巴结复发模式及其复发后的预后进行分析。区域淋巴结复发后的中位随访时间为5.4年。
区域淋巴结复发模式如下：14例（48%）同时出现局部和腋窝复发，7例（24%）仅腋窝复发，5例（17%）仅锁骨上区域复发，3例（10%）多个淋巴结部位复发。整个研究组的5年、10年和15年总生存率分别为70%、37%和28%。局部区域复发患者的10年总生存率为32%，而仅区域复发患者为45%（p = 0.50）。在乳房切除标本病理检查中发现腋窝复发的患者10年总生存率为31%，而可触及区域淋巴结肿大的患者为42%（p = 0.83）。
早期乳腺癌保乳治疗并放疗后出现区域淋巴结复发的患者有可能获得挽救。根据是否同时存在乳腺内复发或检测方法进行分层后，区域淋巴结复发后的预后无显著差异。
