Sarasqueta Cristina, Martínez-Camblor Pablo, Mendiola Arantza, Martínez-Pueyo Iñaki, Michelena Maria Jesús, Basterretxea Mikel, Recio Javier, Alvarez Isabel, Larrañaga Nerea
Hospital Donostia, Donostia-San Sebastián, España.
Med Clin (Barc). 2009 Oct 10;133(13):489-95. doi: 10.1016/j.medcli.2009.03.036. Epub 2009 Jul 25.
Information regarding the incidence and prognosis of women who have suffered a recurrence of breast cancer is very variable. The aim of the present study was to determine the incidence of locoregional (LR) and distant recurrence and the survival and its determining factors after first recurrence.
We included all women resident in Guipuzkoa who were diagnosed with invasive, non-disseminated breast cancer during 1995 and 1996 identified via Guipuzkoa's Cancer Registry. Recurrences that occurred up to December 2004 were determined retrospectively and compared with the National Death Registry of 2007 to determine the mortality. Relative survival was calculated by the Hakulinen method.
Five hundred and sixty one women with tumours in stages I-III were included, 90% of whom were treated with conservative surgery+radiation therapy, or mastectomy. The median follow-up for recurrence was eight years, with 5,7% of these recurrences being LR and 23% distant metastases. The median follow-up after recurrence was 6,1 years for live patients and 1,04 years for dead ones. The three-year survival was 54% (95% CI: 0,31-0,78) after LR recurrence and 18% (95% CI: 0,09-0,28) after distant recurrence. Multivariate analysis showed that the factors that remained as independent predictors of survival after LR recurrence were time to recurrence, age and degree of differentiation of the initial tumour. Age, time to recurrence and nodal involvement were associated with survival after distant recurrence.
Women younger than 54 at initial diagnosis with short disease-free periods and poorly differentiated tumours with nodal involvement have worse prognosis, which should be taken into account when deciding the therapeutic strategy to be followed upon recurrence.
关于乳腺癌复发女性的发病率和预后的信息差异很大。本研究的目的是确定局部区域（LR）和远处复发的发生率以及首次复发后的生存率及其决定因素。
我们纳入了居住在吉普斯夸省的所有女性，她们在1995年至1996年期间经吉普斯夸省癌症登记处确诊为浸润性、非播散性乳腺癌。回顾性确定截至2004年12月发生的复发情况，并与2007年国家死亡登记处进行比较以确定死亡率。采用哈库利宁方法计算相对生存率。
纳入了561例I - III期肿瘤的女性，其中90%接受了保乳手术 + 放疗或乳房切除术。复发的中位随访时间为8年，其中5.7%的复发为LR，23%为远处转移。复发后存活患者的中位随访时间为6.1年，死亡患者为1.04年。LR复发后三年生存率为54%（95%CI：0.31 - 0.78），远处复发后为18%（95%CI：0.09 - 0.28）。多因素分析显示，LR复发后仍作为生存独立预测因素的是复发时间、年龄和初始肿瘤的分化程度。年龄、复发时间和淋巴结受累与远处复发后的生存相关。
初次诊断时年龄小于54岁、无病期短且肿瘤分化差并伴有淋巴结受累的女性预后较差，在决定复发后应采取的治疗策略时应予以考虑。
