Department of Surgery, Dartmouth Medical School, Hanover, NH, USA.
Ann Surg Oncol. 2010 Oct;17 Suppl 3:325-9. doi: 10.1245/s10434-010-1247-1. Epub 2010 Sep 19.
The incidence of preoperatively identified multifocal and multicentric breast cancer is rising with improved sensitivity of imaging modalities. Based on retrospective, historic data, breast conservation in women with multiple tumors has been discouraged because of high rates of local regional recurrence (LRR). These studies, however, do not extrapolate to contemporary practice as they do not incorporate the use of modern therapies and surgical techniques. This study is designed to evaluate the feasibility of breast conservation in women with multiple breast primaries.
We retrospectively reviewed the charts of 22 women who underwent breast conservation surgery for 2 or more synchronous, ipsilateral cancers between 1998 and 2008. We extracted data including tumor size, nodal staging, receptor status, adjuvant therapies administered, and local-regional recurrence.
A total of 22 patients were identified. Average follow up is 3.5 years. One patient (4.5%) experienced an in-breast recurrence. Both initial tumors in this patient were invasive ductal carcinoma, ER/PR, negative and HER2 positive. Time to LRR was 2.5 years.
Our data are consistent with those of recent studies in which multifocal/multicentric local regional recurrence in multicentric/multifocal breast is equivalent to that seen in women with unifocal cancer. The single local recurrence in this study occurred in a premenopausal women with ER/PR- disease who were HER2+. Prior retrospective studies have identified ER/PR- and HER2 overexpression as independent risk factors for recurrence following breast conservation. Additional prospective trials are warranted to better assess the oncologic safety of breast conservation in this population.
随着影像学检查敏感性的提高，术前发现的多灶性和多中心乳腺癌的发病率正在上升。基于回顾性的历史数据，由于局部区域复发（LRR）率较高，不鼓励患有多个肿瘤的女性进行保乳手术。然而，这些研究并不能外推到当代实践，因为它们没有纳入现代治疗和手术技术的使用。本研究旨在评估在多个乳腺原发性肿瘤患者中进行保乳手术的可行性。
我们回顾性地分析了 1998 年至 2008 年间 22 例接受 2 个或更多同侧同步乳腺癌保乳手术的女性的病历。我们提取了包括肿瘤大小、淋巴结分期、受体状态、辅助治疗和局部区域复发等数据。
共确定了 22 例患者。平均随访时间为 3.5 年。1 例患者（4.5%）出现了乳腺内复发。该患者的最初两个肿瘤均为浸润性导管癌，ER/PR 阴性，HER2 阳性。LRR 时间为 2.5 年。
我们的数据与最近的研究一致，即多灶性/多中心乳腺癌的多灶性/多中心局部区域复发与单灶性乳腺癌相似。本研究中唯一的局部复发发生在一位 ER/PR-疾病且 HER2+的绝经前妇女。先前的回顾性研究已经确定 ER/PR-和 HER2 过表达是保乳后复发的独立危险因素。需要进一步的前瞻性试验来更好地评估该人群中保乳的肿瘤学安全性。
