Boyages J, Recht A, Connolly J L, Schnitt S J, Gelman R, Kooy H, Love S, Osteen R T, Cady B, Silver B
Joint Center for Radiation Therapy, Harvard Medical School, Boston, Massachussetts.
Radiother Oncol. 1990 Sep;19(1):29-41. doi: 10.1016/0167-8140(90)90163-q.
The identification of factors associated with breast recurrence following conservative surgery (CS) and radiation therapy (RT) is of potential use in refining patient selection criteria and treatment technique. In an attempt to define such factors we examined the relationship between various clinical, pathologic and treatment characteristics and the likelihood of breast recurrence in 783 patients with clinical stage I or II breast cancer treated between July 1968 and December 1982. Treatment consisted of complete gross excision of the primary tumor and RT to a total dose of at least 60 Gy to the primary site. During this period, pre-treatment mammograms and detailed histologic assessment of the margins of resection were not routinely performed. Median follow-up for surviving patients was 80 months. Thirteen patients (1.6%) were lost to follow-up. Ninety-one patients (12%) have developed a breast recurrence, corresponding to 5- and 10-year actuarial rates of 10 and 18%, respectively. The major feature associated with breast recurrence was the presence of an "extensive intraductal component" (EIC+). An EIC+ tumor was seen in 28% of evaluable cases with infiltrating ductal carcinoma and accounted for 60% of breast recurrences. Forty-three of 166 patients (26%) with EIC+ tumors developed a breast recurrence compared with 29 of 418 patients (7%) without an EIC (EIC-) (p = 0.0001). The 5-year actuarial rates of breast relapse were 24 and 6%, respectively (p = 0.0001). Very young age (defined as 34 years of age or younger) was also a significant factor associated with the risk of breast recurrence. Very young patients comprised 8% of the patient population and accounted for 16% of breast recurrences. Fifteen of 61 very young patients (25%) developed a breast recurrence compared with 76 of 722 older patients (11%) (p = 0.001). The corresponding 5-year actuarial rates of breast recurrence were 21 and 9% (p = 0.005). None of the other clinical or pathological factors examined by univariate analysis were significantly correlated with recurrence in the breast. A multivariate model of site of first failure (polychotomous logistic regression) also showed that EIC+ tumors and very young age were the main factors associated with a high relative risk of breast recurrence. We conclude that EIC+ tumors and very young age are associated with a high risk of breast recurrence for patients treated with limited excision prior to RT.
确定保乳手术（CS）和放射治疗（RT）后与乳腺复发相关的因素，对于完善患者选择标准和治疗技术具有潜在用途。为了明确这些因素，我们研究了783例1968年7月至1982年12月间接受治疗的临床I期或II期乳腺癌患者的各种临床、病理和治疗特征与乳腺复发可能性之间的关系。治疗包括对原发肿瘤进行完整的大体切除，并对原发部位进行至少60 Gy的放疗。在此期间，未常规进行治疗前乳房X线摄影和切除边缘的详细组织学评估。存活患者的中位随访时间为80个月。13例患者（1.6%）失访。91例患者（12%）出现乳腺复发，5年和10年精算复发率分别为10%和18%。与乳腺复发相关的主要特征是存在“广泛导管内成分”（EIC+）。在28%的可评估浸润性导管癌病例中可见EIC+肿瘤，且占乳腺复发的60%。166例EIC+肿瘤患者中有43例（26%）出现乳腺复发，而418例无EIC（EIC-）患者中有29例（7%）出现复发（p = 0.0001）。乳腺复发的5年精算率分别为24%和6%（p = 0.0001）。非常年轻的年龄（定义为34岁及以下）也是与乳腺复发风险相关的一个重要因素。非常年轻的患者占患者总数的8%，占乳腺复发的16%。61例非常年轻的患者中有15例（25%）出现乳腺复发，而722例年龄较大的患者中有76例（11%）出现复发（p = 0.001）。相应的乳腺复发5年精算率分别为21%和9%（p = 0.005）。单因素分析中所研究的其他临床或病理因素均与乳腺复发无显著相关性。首次复发部位的多变量模型（多分类逻辑回归）也显示，EIC+肿瘤和非常年轻的年龄是与乳腺复发相对风险高相关的主要因素。我们得出结论，对于放疗前接受有限切除治疗的患者，EIC+肿瘤和非常年轻的年龄与乳腺复发高风险相关。
