Department of Surgical Oncology, The University of Texas, M. D. Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2011 Oct;18(11):3164-73. doi: 10.1245/s10434-011-1920-z. Epub 2011 Sep 27.
Triple-negative breast cancer (TNBC) is an aggressive subtype shown to have a high risk of locoregional recurrence (LRR). The purpose of this study was to determine the impact of operation type on LRR in TNBC patients.
A total of 1325 patients with TNBC who underwent breast-conserving therapy (BCT) or mastectomy from 1980 to the present were identified. Clinical and pathological factors were compared by the chi-square test. LRR-free survival (LRRFS), distant metastasis-free survival, and overall survival were estimated by the Kaplan-Meier method. Multivariate analysis was performed by the Cox proportional hazard models.
BCT was performed in 651 patients (49%) and mastectomy in 674 (51%). The mastectomy group had larger tumors, a higher incidence of lymphovascular invasion, and higher pathologic N stage (all P < 0.001). At 62-month median follow-up, LRR was seen in 170 (26%) in the BCT group and 203 (30%) in the mastectomy group. Five-year LRRFS rates were higher in the BCT group (76% vs. 71%, P = 0.032), as was distant metastasis-free survival (68% vs. 54%, P < 0.0001) and overall survival (74% vs. 63%, P < 0.0001). On multivariate analysis, T stage (hazard ratio [HR] 1.37, P = 0.006), high nuclear grade (HR 1.92, P = 0.002), lymphovascular invasion (HR 1.93, P < 0.0001), close/positive margins (HR 1.89, P < 0.0001), and use of non-anthracycline or taxane-based adjuvant chemotherapy (HR 2.01, P < 0.0001) increased the LRR risk, while age >50 years was protective (HR 0.73, P = 0.007). Operation type (mastectomy vs. BCT, HR 1.07, P = 0.55) was not statistically significant.
BCT is not associated with increased LRR rates compared to mastectomy. TNBC should not be considered a contraindication for breast conservation.
三阴性乳腺癌（TNBC）是一种侵袭性亚型，具有较高的局部区域复发（LRR）风险。本研究的目的是确定手术类型对 TNBC 患者 LRR 的影响。
从 1980 年至今，共确定了 1325 例接受保乳治疗（BCT）或乳房切除术的 TNBC 患者。通过卡方检验比较临床和病理因素。通过 Kaplan-Meier 法估计 LRR 无复发生存（LRRFS）、远处转移无复发生存和总生存。通过 Cox 比例风险模型进行多变量分析。
651 例（49%）患者接受 BCT，674 例（51%）患者接受乳房切除术。与 BCT 组相比，乳房切除术组的肿瘤更大，淋巴血管侵犯发生率更高，病理 N 分期更高（均 P < 0.001）。在中位随访 62 个月时，BCT 组有 170 例（26%）和乳房切除术组有 203 例（30%）发生 LRR。BCT 组的 5 年 LRRFS 率更高（76%比 71%，P = 0.032），远处转移无复发生存率（68%比 54%，P < 0.0001）和总生存率（74%比 63%，P < 0.0001）也更高。多变量分析显示，T 分期（风险比 [HR] 1.37，P = 0.006）、高核分级（HR 1.92，P = 0.002）、淋巴血管侵犯（HR 1.93，P < 0.0001）、切缘近或阳性（HR 1.89，P < 0.0001）和非蒽环类或紫杉类辅助化疗（HR 2.01，P < 0.0001）增加了 LRR 风险，而年龄 >50 岁则具有保护作用（HR 0.73，P = 0.007）。手术类型（乳房切除术与 BCT，HR 1.07，P = 0.55）无统计学意义。
与乳房切除术相比，BCT 并不增加 LRR 发生率。TNBC 不应被视为保乳的禁忌症。
