Department of Hematology/Oncology, Santa Clara Valley Medical Center, Santa Clara, CA, USA.
Am J Surg. 2009 Dec;198(6):771-80. doi: 10.1016/j.amjsurg.2009.05.027.
A significant proportion of patients undergoing breast conservation therapy require additional operations to obtain clear margins. The aim of this study was to assess the impact of initial margins and residual carcinoma found on second surgery on the outcomes of breast cancer patients.
In this retrospective study, Cox proportional-hazard regression analysis was performed to evaluate data from 437 patients with stage I to IIIA breast cancer who underwent initial breast-conserving surgery between 1994 and 2004.
The distant recurrence rate was higher among patients with initial positive margins than among those with initial negative margins (15.5% vs 4.9%; hazard ratio, 3.6; 95% confidence interval 1.5-8.7; P = .003). For patients who had underwent second surgery, the finding of a residual invasive carcinoma was associated with increased risk for distant recurrence (22.8% vs 6.6%; hazard ratio, 3.5; 95% confidence interval, 1.8-7.4; P = .0001).
Invasive residual carcinoma found during subsequent surgery after initial compromised margins is an important prognostic marker for distant recurrence.
相当一部分接受保乳治疗的患者需要进行额外的手术以获得切缘清晰。本研究旨在评估初始切缘和第二次手术时发现的残留癌对乳腺癌患者结局的影响。
在这项回顾性研究中，我们对 1994 年至 2004 年间接受初始保乳手术的 I 期至 IIIA 期乳腺癌患者的资料进行了 Cox 比例风险回归分析，共纳入 437 例患者。
初始切缘阳性的患者远处复发率高于初始切缘阴性的患者（15.5% vs. 4.9%；危险比，3.6；95%置信区间 1.5-8.7；P =.003）。对于接受第二次手术的患者，发现有残留浸润性癌与远处复发风险增加相关（22.8% vs. 6.6%；危险比，3.5；95%置信区间 1.8-7.4；P =.0001）。
在初始切缘不佳的情况下，后续手术中发现的浸润性残留癌是远处复发的重要预后标志物。
