保乳治疗后同侧乳房肿瘤复发的分类可以预测患者的预后，并有助于治疗计划的制定。
Classification of ipsilateral breast tumor recurrences after breast conservation therapy can predict patient prognosis and facilitate treatment planning.
机构信息
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, TX, USA.
出版信息
Ann Surg. 2011 Mar;253(3):572-9. doi: 10.1097/SLA.0b013e318208fc2a.
OBJECTIVE
To classify ipsilateral breast tumor recurrences (IBTR) as either new primary tumors (NP) or true local recurrence (TR). We utilized 2 different methods and compared sensitivities and specificities between them. Our goal was to determine whether distinguishing NP from TR had prognostic value.
BACKGROUND
After breast-conservation therapy, IBTR may be classified into 2 distinct types (NP and TR). Studies have attempted to classify IBTR by using tumor location, histologic subtype, DNA flow cytometry data, or gene-expression profiling data.
METHODS
A total of 447 (7.9%) of 5660 patients undergoing breast-conservation therapy from 1970 to 2005 experienced IBTR. Clinical data from 397 patients were available for review. We classified IBTRs as NP or TR on the basis of either tumor location and histologic subtype (method 1) or tumor location, histologic subtype, estrogen receptor status and human epidermal growth factor receptor 2 status (method 2). Kaplan-Meier curves and log-rank tests were used to evaluate overall and disease-specific survival differences between the 2 groups. Classification methods were validated by calculating sensitivity and specificity values using a Bayesian method.
RESULTS
Of 397 patients, 196 (49.4%) were classified as NP by method 1 and 212 (53.4%) were classified as NP by method 2. The sensitivity and specificity values were 0.812 and 0.867 for method 1 and 0.870 and 0.800 for method 2, respectively. Regardless of method used, patients classified as NP developed contralateral breast carcinoma more often but had better 10-year overall and disease-specific survival rates than those classified as TR. Patients with TR were more likely to develop metastatic disease after IBTR.
CONCLUSION
Ipsilateral breast tumor recurrences classified as TR and NP had clinically different features, suggesting that classifying IBTR may provide clinically significant data for the management of IBTR.
目的
将同侧乳房肿瘤复发（IBTR）分为新原发肿瘤（NP）或真正的局部复发（TR）。我们使用了 2 种不同的方法，并比较了它们的敏感性和特异性。我们的目标是确定区分 NP 和 TR 是否具有预后价值。
背景
在保乳治疗后，IBTR 可分为 2 种不同类型（NP 和 TR）。研究试图通过肿瘤位置、组织学亚型、DNA 流式细胞术数据或基因表达谱数据来对 IBTR 进行分类。
方法
1970 年至 2005 年，共有 5660 例接受保乳治疗的患者中有 447 例（7.9%）发生 IBTR。对 397 例患者的临床资料进行了回顾。我们根据肿瘤位置和组织学亚型（方法 1）或肿瘤位置、组织学亚型、雌激素受体状态和人表皮生长因子受体 2 状态（方法 2）将 IBTR 分为 NP 或 TR。使用 Kaplan-Meier 曲线和对数秩检验评估两组之间的总生存率和疾病特异性生存率差异。通过使用贝叶斯方法计算敏感性和特异性值来验证分类方法。
结果
在 397 例患者中，196 例（49.4%）根据方法 1 被分类为 NP，212 例（53.4%）根据方法 2 被分类为 NP。方法 1 的敏感性和特异性值分别为 0.812 和 0.867，方法 2 的敏感性和特异性值分别为 0.870 和 0.800。无论使用哪种方法，被分类为 NP 的患者发生对侧乳腺癌的频率更高，但 10 年总生存率和疾病特异性生存率均优于被分类为 TR 的患者。TR 患者在发生 IBTR 后更有可能发生转移性疾病。
结论
分类为 TR 和 NP 的同侧乳房肿瘤复发具有临床不同的特征，这表明对 IBTR 的分类可能为 IBTR 的管理提供具有临床意义的数据。
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