Beard H Randall, Cantrell Emily F, Russell Gregory B, Howard-McNatt Marissa, Shen Perry, Levine Edward A
Surgical Oncology Service of Wake Forest University, Winston-Salem, North Carolina 27157, USA.
Am Surg. 2010 Aug;76(8):829-34.
Ipsilateral breast tumor recurrence (IBTR) is a risk after breast conserving surgery, and is traditionally treated with mastectomy. Given the limited literature on outcome after mastectomy for IBTR, we evaluated our long-term data for this group. A retrospective review was conducted using a database of 2101 breast cancer patients at a single institution. Fifty-nine patients underwent breast conserving surgery and experienced an IBTR. Exclusion criteria included repeat lumpectomy or metastatic disease before mastectomy. Patients presented with invasive ductal (58%), invasive lobular (7%), other invasive (11%), or ductal carcinoma in situ (24%). Initial tumors were Tis (24%), T1 (42%), T2 (20%), T3 (2%), or not recorded (12%). IBTR lesions were Tis (20%), T1 (46%), T2 (25%), or T3 (9%). Median follow-up after mastectomy was 4.6 years. Thirteen patients (22%) had postmastectomy recurrence (PMR), which decreased overall survival (P = 0.002). PMR was more common with larger IBTR tumors (P = 0.03), specifically IBTR > or = T2 (P = 0.003). Eighty-five per cent of PMR occurred within 2 years of mastectomy. Mastectomy for IBTR remains effective treatment for most patients, but the risk of PMR remains. Patients with IBTR tumors >2 cm have an increased risk of PMR. Strict follow-up should be routine, especially during the first 24 months.
保乳手术后同侧乳腺肿瘤复发（IBTR）是一种风险，传统上采用乳房切除术治疗。鉴于关于IBTR乳房切除术后结局的文献有限，我们评估了该组患者的长期数据。使用单一机构的2101例乳腺癌患者数据库进行了回顾性研究。59例患者接受了保乳手术并出现IBTR。排除标准包括乳房切除术前重复进行肿块切除术或转移性疾病。患者表现为浸润性导管癌（58%）、浸润性小叶癌（7%）、其他浸润性癌（11%）或导管原位癌（24%）。初始肿瘤为Tis（24%）、T1（42%）、T2（20%）、T3（2%）或未记录（12%）。IBTR病变为Tis（20%）、T1（46%）、T2（25%）或T3（9%）。乳房切除术后的中位随访时间为4.6年。13例患者（22%）出现乳房切除术后复发（PMR），这降低了总生存率（P = 0.002）。PMR在较大的IBTR肿瘤中更常见（P = 0.03），特别是IBTR≥T2（P = 0.003）。85%的PMR发生在乳房切除术后2年内。对于大多数患者，IBTR乳房切除术仍然是有效的治疗方法，但PMR的风险仍然存在。IBTR肿瘤>2 cm的患者PMR风险增加。应常规进行严格随访，尤其是在最初的24个月内。
