Kurtz J M, Jacquemier J, Amalric R, Brandone H, Ayme Y, Hans D, Bressac C, Roth J, Spitalier J M
Department of Radiation Oncology, University Hospital, Basel, Switzerland.
Cancer. 1990 Apr 15;65(8):1867-78. doi: 10.1002/1097-0142(19900415)65:8<1867::aid-cncr2820650833>3.0.co;2-i.
Risk factors for local failure were evaluated for 496 clinical Stage I-II patients with infiltrating ductal carcinomas (median follow-up, 71 months) treated by conservative surgery and radiotherapy. Monofactorial analysis identified the following factors to be correlated with increased risk: moderate/marked mononuclear cell reaction (MCR), high histologic grade (G), extensive intraductal component (EIC), tumor necrosis, macroscopic multiplicity, estrogen receptor negativity, anatomic tumor size, age younger than 40 years, and vascular invasion. Only MCR, G, and EIC proved significant in Cox multivariate analysis. These risk factors were highly age dependent, with EIC markedly more prevalent in women younger than 50, MCR and G in women younger than 40. Separate Cox analysis for premenopausal patients showed that MCR/EIC determined risk independent of resection margins: tumors with MCR had a 28%, and with EIC a 22% probability of recurring locally by 5 years. Premenopausal patients with neither risk factor had a very low failure rate (2.6% at 5 years), regardless of age. For postmenopausal patients risk of breast recurrence was determined both by adequacy of resection margins and grade, with a high local failure rate for patients having G3 tumors with positive or indeterminate margins (31% at 5 years). The authors conclude that the microscopic examination is the only useful tool for assessing the risk of local failure, which is quite low for the majority of patients treated with breast conservation. High-risk patients can be recognized morphologically. The age dependence of morphologic risk factors appears to explain the high local failure rate seen in patients younger than 40.
对496例浸润性导管癌临床I-II期患者进行了局部复发危险因素评估，这些患者接受了保乳手术和放疗（中位随访时间71个月）。单因素分析确定以下因素与风险增加相关：中度/显著单核细胞反应（MCR）、高组织学分级（G）、广泛导管内成分（EIC）、肿瘤坏死、肉眼可见多灶性、雌激素受体阴性、肿瘤解剖学大小、年龄小于40岁以及血管侵犯。在Cox多因素分析中，只有MCR、G和EIC被证明具有显著性。这些危险因素高度依赖年龄，EIC在50岁以下女性中明显更为普遍，MCR和G在40岁以下女性中更为普遍。对绝经前患者进行的单独Cox分析显示，MCR/EIC决定风险，与手术切缘无关：有MCR的肿瘤5年内局部复发概率为28%，有EIC的为22%。无论年龄如何，没有这些危险因素的绝经前患者复发率非常低（5年时为2.6%）。对于绝经后患者，乳腺复发风险由手术切缘的充分性和分级共同决定，切缘阳性或不确定的G3级肿瘤患者局部复发率较高（5年时为31%）。作者得出结论，显微镜检查是评估局部复发风险的唯一有用工具，对于大多数接受保乳治疗的患者来说，这种风险相当低。高危患者可以通过形态学识别。形态学危险因素的年龄依赖性似乎解释了40岁以下患者中较高的局部复发率。
