Eryilmaz M A, Muslumanoglu M, Ozmen V, Igci A, Koc M
Konya Education and Research Hospital, General Surgery Clinic, Konya, Turkey.
J BUON. 2011 Jul-Sep;16(3):450-3.
To retrospectively evaluate the outcome of patients with multifocal (MF) and multicentric (MC) breast cancer treated with conservative surgery.
We evaluated 59 patients who had undergone breast conserving surgery (BCS) for MF/MC cancer between 1998-2008. We used sentinel lymph node (SLN) biopsy for all 59 patients and we performed axillary lymph node dissection in those with positive SLN. Local control, overall survival (OS), disease-free survival (DFS) and identification of predictive factors for recurrence were evaluated.
Twenty patients with modified radical mastectomy because of persistent positive margins were excluded from the study. Evaluated were 55 patients with MF (93.2%) and 4 (6.8%) with MC disease. Thirty-four patients (57.6%) had 2, 20 patients (33.9%) had 3 and 5 (8.5%) had 4 or more tumor foci. Median follow up time was 20 months (range 2- 97). The projected 5- and 8-year OS were 95% and 89% respectively, and DFS 92.3%. At multivariate analysis, overexpression of human epidermal growth factor receptor 2 (HER-2) was associated with a higher ipsilateral breast cancer recurrence. Menopausal status, MF/MC disease, number of tumor foci (2 vs. ≥3), histological grade, extracapsular extension (ECE), lymphovascular invasion (LVI), and hormone receptor status were not associated with ipsilateral breast cancer recurrence.
Our study demonstrates that in selected patients with MF/MC breast cancer, wide conservative surgery is a safe therapy.
回顾性评估采用保乳手术治疗多灶性（MF）和多中心性（MC）乳腺癌患者的预后。
我们评估了1998年至2008年间因MF/MC癌接受保乳手术（BCS）的59例患者。对所有59例患者均采用前哨淋巴结（SLN）活检，对SLN阳性患者行腋窝淋巴结清扫术。评估局部控制情况、总生存期（OS）、无病生存期（DFS）以及复发预测因素的识别。
20例因切缘持续阳性而行改良根治性乳房切除术的患者被排除在研究之外。评估的患者中，55例为MF（93.2%），4例为MC疾病（6.8%）。34例患者（57.6%）有2个肿瘤病灶，20例患者（33.9%）有3个肿瘤病灶，5例患者（8.5%）有4个或更多肿瘤病灶。中位随访时间为20个月（范围2至97个月）。预计5年和8年总生存率分别为95%和89%，无病生存率为92.3%。多因素分析显示，人表皮生长因子受体2（HER-2）过表达与同侧乳腺癌复发率较高相关。绝经状态、MF/MC疾病、肿瘤病灶数量（2个与≥3个）、组织学分级、包膜外扩展（ECE）、淋巴管浸润（LVI）以及激素受体状态与同侧乳腺癌复发无关。
我们的研究表明，对于选定的MF/MC乳腺癌患者，广泛保乳手术是一种安全的治疗方法。
