Department of Radiation Oncology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Clin Breast Cancer. 2011 Dec;11(6):400-5. doi: 10.1016/j.clbc.2011.08.003. Epub 2011 Oct 10.
The current study examined the impact of re-excision and residual disease on local recurrence after breast conservation treatment for patients with negative margins. Patients with residual disease on re-excision had a higher local recurrence rate than other patients. However, with reasonably low local recurrence rates in all subgroups, neither re-excision nor residual disease on re-excision are contraindications for breast conservation treatment.
To evaluate the impact of re-excision and the presence of residual disease on local recurrence for patients who underwent breast conservation treatment (BCT) with negative final resection margins.
The records of 902 patients with stage I or II unilateral invasive breast cancer who had BCT were reviewed. The study cohort consisted of patients with negative final resection margins and was divided into 3 subgroups: (a) single excision (n = 332 [37%]), (b) re-excision with no residual disease in the re-excision specimen (n = 440 [49%]), and (c) re-excision with residual disease in the re-excision specimen (n = 130 [14%]). The median follow-up was 6.75 years.
At 15 years, the rates of local failure were 10% for patients with a single excision, 10% for patients with a re-excision without residual disease, and 16% for patients with a re-excision with residual disease (P = .033). There were no significant differences between the 3 groups for overall survival, cause-specific survival, relapse-free survival, or freedom from distant metastases (all P ≥ .082). Multivariate analysis demonstrated an increased risk of local failure for patients with residual disease in the re-excision specimen that was borderline statistically significant (hazard ratio, 2.16; P = .061).
Despite achieving negative final resection margins, the patients with residual disease in the re-excision specimen had a higher rate of local recurrence than patients who underwent single excision or patients without residual disease on re-excision. However, local recurrence was reasonably low in all 3 subgroups, and, therefore, neither re-excision nor residual disease represent contraindications for BCT.
评估在最终切缘阴性的患者中，再次切除和残留疾病对保乳治疗（BCT）局部复发的影响。
回顾了 902 例接受单侧 I 期或 II 期浸润性乳腺癌 BCT 的患者的记录。研究队列由最终切缘阴性的患者组成，分为 3 个亚组：（a）单次切除（n=332[37%]）、（b）再次切除且再次切除标本无残留疾病（n=440[49%]）和（c）再次切除且再次切除标本有残留疾病（n=130[14%]）。中位随访时间为 6.75 年。
在 15 年时，单次切除患者、再次切除无残留疾病患者和再次切除有残留疾病患者的局部失败率分别为 10%、10%和 16%（P=0.033）。3 组患者在总生存、疾病特异性生存、无复发生存和无远处转移生存方面均无显著差异（均 P≥0.082）。多变量分析显示，再次切除标本有残留疾病的患者局部失败风险增加，但具有统计学意义（危险比，2.16；P=0.061）。
尽管达到了最终切缘阴性，但再次切除标本有残留疾病的患者局部复发率高于单次切除患者或再次切除无残留疾病的患者。然而，所有 3 个亚组的局部复发率均较低，因此，再次切除或残留疾病均不是 BCT 的禁忌证。
