Department of Surgery, Division of Surgical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
J Am Coll Surg. 2012 Jul;215(1):137-46; discussion 146-7. doi: 10.1016/j.jamcollsurg.2012.05.006. Epub 2012 May 18.
There is controversy about whether breast conserving therapy (BCT) should be contraindicated in multifocal (MF) breast cancer. Few studies have reported on the oncologic safety of BCT in MF breast cancer.
We reviewed a prospective database of 1,169 women with invasive breast cancer who were treated with segmentectomy and whole breast irradiation from 1991 through 2009 and followed at our institution. Multifocal breast cancer was defined as 2 or more distinct tumors excised with a single incision or segmentectomy. We compared 2 groups, MF and unifocal breast cancer patients, with respect to demographics, tumor characteristics, adjuvant systemic therapy, local recurrence (LR), disease-free survival (DFS), and overall survival (OS).
One hundred sixty-four patients with MF and 999 with unifocal invasive breast cancer were treated with BCT. Median follow-up was 112 months. Compared with the unifocal group, patients in the MF group had higher 10-year LR (0.6% vs 6.1%, p < 0.001) and lower 10-year DFS (97.7% vs 89.3%, p < 0.001) and OS (98.4% vs 85.8%, p < 0.001). On multivariable analysis, multifocality was independently significantly associated with local recurrence-free survival (LRFS), DFS, and OS.
Our data suggest that BCT in MF breast cancer is oncologically safe but may result in a slightly inferior outcome compared with BCT in unifocal breast cancer.
保乳治疗（BCT）是否应在多灶性（MF）乳腺癌中被禁忌存在争议。很少有研究报告 MF 乳腺癌中 BCT 的肿瘤安全性。
我们回顾了 1991 年至 2009 年在我们机构接受区段切除术和全乳照射治疗的 1169 例浸润性乳腺癌女性的前瞻性数据库。多灶性乳腺癌定义为 2 个或更多单独切除的不同肿瘤，采用单个切口或节段切除术。我们比较了 MF 和单灶性乳腺癌患者在人口统计学、肿瘤特征、辅助全身治疗、局部复发（LR）、无病生存（DFS）和总生存（OS）方面的差异。
164 例 MF 和 999 例单灶性浸润性乳腺癌患者接受了 BCT。中位随访时间为 112 个月。与单灶组相比，MF 组患者的 10 年 LR 更高（0.6% vs. 6.1%，p < 0.001），10 年 DFS 和 OS 更低（97.7% vs. 89.3%，p < 0.001 和 98.4% vs. 85.8%，p < 0.001）。多变量分析显示，多灶性与无局部复发生存（LRFS）、DFS 和 OS 独立显著相关。
我们的数据表明，MF 乳腺癌中的 BCT 在肿瘤学上是安全的，但与单灶性乳腺癌中的 BCT 相比，可能会导致略差的结果。
