Mayo Medical School, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Ann Surg Oncol. 2012 Apr;19(4):1153-9. doi: 10.1245/s10434-011-2084-6. Epub 2011 Oct 12.
Local recurrence (LR) after breast conservation surgery (BCS) varies with risk factors. This study was designed to evaluate the impact of young age on LR.
All patients (excluding those who received neoadjuvant chemotherapy) who underwent BCS from 1988-2001 at our institution were identified and evaluated for risk factors of LR.
A total of 3,064 patients underwent 3,131 BCS. Mean age at surgery was 61 (range, 21-98) years: 175 (5.6%) patients were aged<40 years; 492 (15.7%) were 40-49 years; 761 (24.3%) were 50-59 years; 801 (25.6%) were 60-69 years; and 902 (28.8%) were age 70+years. A total of 212 patients (6.8%) developed LR at a mean of 4.5 (range, 0.1-14.4) years after BCS. Mean follow-up was 8.9 (range, 0-20.2) years. The 5-year LR-free survival rate was 94.9%. The frequencies of LR by age group were: <40 years--11.4%; 40-49 years--5.7%; 50-59 years--6.2%; 60-69 years--7.6%; 70 years and older--6.2%. The 5-year LR-free survival rates for these age groups were 90.5%, 95.4%, 95.5%, 95.4%, and 94.7%, respectively (P=0.09, log-rank test). On univariable analysis, patients aged<40 years were nearly twice as likely to experience LR (hazards ratio (HR), 1.81; P=0.012). Multivariable analysis of patients with complete data (n=2,122) demonstrated that age<40 years and node positivity were associated with increased risk of LR, whereas ER positivity and radiation therapy were associated with decreased risk.
Risk factors for LR after BCS include age<40 years, node positivity, ER negativity, and absence of adjuvant radiation therapy. Patients younger than age 40 years are at increased risk of LR after BCS.
保乳手术后（BCS）的局部复发（LR）随危险因素而变化。本研究旨在评估年龄因素对 LR 的影响。
本机构对所有接受 BCS 的患者（不包括接受新辅助化疗的患者）进行了识别和 LR 危险因素评估。
共 3064 例患者行 3131 例 BCS。手术时的平均年龄为 61（范围，21-98）岁：175（5.6%）例患者年龄<40 岁；492（15.7%）例患者年龄 40-49 岁；761（24.3%）例患者年龄 50-59 岁；801（25.6%）例患者年龄 60-69 岁；902（28.8%）例患者年龄 70 岁及以上。212 例（6.8%）患者在 BCS 后平均 4.5（范围，0.1-14.4）年时发生 LR。中位随访时间为 8.9（范围，0-20.2）年。5 年无 LR 生存率为 94.9%。按年龄组划分的 LR 频率为：<40 岁-11.4%；40-49 岁-5.7%；50-59 岁-6.2%；60-69 岁-7.6%；70 岁及以上-6.2%。这些年龄组的 5 年无 LR 生存率分别为 90.5%、95.4%、95.5%、95.4%和 94.7%（P=0.09，对数秩检验）。单变量分析显示，<40 岁的患者发生 LR 的可能性几乎是两倍（风险比（HR）1.81；P=0.012）。对具有完整数据的 2122 例患者进行多变量分析显示，<40 岁和淋巴结阳性与 LR 风险增加相关，而 ER 阳性和放疗与 LR 风险降低相关。
BCS 后 LR 的危险因素包括年龄<40 岁、淋巴结阳性、ER 阴性和缺乏辅助放疗。年龄<40 岁的患者在 BCS 后 LR 风险增加。
