Yale University School of Medicine, New Haven, CT 06520-8040, USA.
Int J Radiat Oncol Biol Phys. 2010 Jan 1;76(1):79-84. doi: 10.1016/j.ijrobp.2009.01.039.
To compare mammographically occult (MamOcc) and mammographically positive (MamPos) early-stage breast cancer patients treated with breast-conservation therapy (BCT), to analyze differences between the two cohorts.
Our two cohorts consisted of 214 MamOcc and 2168 MamPos patients treated with BCT. Chart reviews were conducted to assess mammogram reports and method of detection. All clinical-pathologic and outcome parameters were analyzed to detect differences between the two cohorts.
Median follow-up was 7 years. There were no differences in final margins, T stage, nodal status, estrogen/progesterone receptor status, or "triple-negative" status. Significant differences included younger age at diagnosis (p < 0.0001), more positive family history (p = 0.0033), less HER-2+ disease (p = 0.0294), and 1 degrees histology (p < 0.0001). At 10 years, the differences in overall survival, cause-specific survival, and distant relapse between the two groups did not differ significantly. The MamOcc cohort had more breast relapses (15% vs. 8%; p = 0.0357), but on multivariate analysis this difference was not significant (hazard ratio 1.0, 95% confidence interval 0.993-1.007, p = 0.9296). Breast relapses were mammographically occult in 32% of the MamOcc and 12% of the MamPos cohorts (p = 0.0136).
Although our study suggests that there are clinical-pathologic variations for the MamOcc cohort vs. MamPos patients that may ultimately affect management, breast relapse after BCT was not significantly different. Breast recurrences were more often mammographically occult in the MamOcc cohort; consideration should be given to closer follow-up and alternative imaging strategies (ultrasound, breast MRI) for routine posttreatment examination. To our knowledge, this represents the largest series addressing the prognostic significance of MamOcc cancers treated with BCT.
比较接受保乳治疗（BCT）的乳腺钼靶摄影术（MamOcc）隐匿性和乳腺钼靶摄影术阳性（MamPos）早期乳腺癌患者，分析两组间的差异。
我们的两个队列包括 214 例 MamOcc 和 2168 例 MamPos 接受 BCT 治疗的患者。进行了病历回顾，以评估乳腺 X 线报告和检测方法。分析了所有临床病理和结局参数，以检测两组间的差异。
中位随访时间为 7 年。两组在最终切缘、T 分期、淋巴结状态、雌激素/孕激素受体状态或“三阴性”状态方面无差异。显著差异包括诊断时年龄较小（p<0.0001）、阳性家族史更多（p=0.0033）、HER-2+疾病较少（p=0.0294）和 1 级组织学（p<0.0001）。10 年时，两组间的总生存、无病生存和远处复发的差异无统计学意义。MamOcc 组的乳房局部复发率较高（15% vs. 8%；p=0.0357），但多变量分析差异无统计学意义（风险比 1.0，95%置信区间 0.993-1.007，p=0.9296）。MamOcc 组的乳房局部复发中有 32%是乳腺钼靶摄影术隐匿性的，而 MamPos 组为 12%（p=0.0136）。
尽管我们的研究表明，MamOcc 队列与 MamPos 患者在临床病理方面存在差异，这些差异可能最终影响治疗，但 BCT 后乳房复发无显著差异。MamOcc 组的乳房复发更常为乳腺钼靶摄影术隐匿性的；考虑对常规治疗后检查进行更密切的随访和替代影像学策略（超声、乳腺 MRI）。据我们所知，这是关于接受 BCT 治疗的 MamOcc 癌症的预后意义的最大系列研究。
