Ann Surg Oncol. 2013 Dec;20(13):4153-60. doi: 10.1245/s10434-013-3202-4.
The role and outcome of radical surgery in contemporary multidisciplinary management of breast cancer patients presenting with isolated sternal or fullthickness chest wall (SCW) recurrence are undefined compared with patients treated without surgery.
Detailed analyses of all patients with isolated SCW recurrence treated from 1992 to 2011 at a large cancer institution were performed. Univariate and multivariate comparisons of clinicopathologic and treatment characteristics were analyzed. Overall and progression-free survival were compared using the Kaplan–Meier method.
Seventy-six patients were identified, 44 treated surgically and 32 nonsurgically. Overall survival at 5 years was not statistically different between patients who underwent surgery and those who did not (30.6 and 49.6 %, respectively; P = 0.52) although patients selected for surgery presented with more advanced and biologically aggressive disease. Surgically treated patients were more likely to have triple-negative breast cancer at recurrence (52 vs. 17 %; P = 0.006). Among surgical patients, 95 % received preoperative systemic therapy. Clinical response with systemic therapy was significantly different, with surgically treated patients more likely to have responsive or stable disease (54 vs. 25 %, P = 0.04). Complications related to radical surgical resection occurred in 25 % of patients. For hormone receptor–positive recurrence, 5-year progression-free survival was significantly higher among surgical patients (46.3 vs. 14.5 %; P = 0.01).
Among patients with isolated SCW recurrence, hormone receptor-positive recurrence is associated with improved survival. Systemic therapy should be the initial treatment, and clinical response can be used to help select patients who may benefit from radical resection.
与未接受手术治疗的患者相比，在当前乳腺癌患者多学科综合管理中，行根治性手术的角色和结局对于伴孤立性胸骨或全层胸壁（SCW）复发的患者尚不明确。
对 1992 年至 2011 年在一家大型癌症机构接受治疗的所有孤立性 SCW 复发患者进行详细分析。分析了临床病理和治疗特征的单变量和多变量比较。采用 Kaplan-Meier 法比较总生存率和无进展生存率。
共确定了 76 例患者，其中 44 例接受了手术治疗，32 例未接受手术治疗。手术组和未手术组患者的 5 年总生存率无统计学差异（分别为 30.6%和 49.6%；P=0.52），尽管手术组患者的疾病分期更晚，生物学侵袭性更强。手术组患者在复发时更有可能患有三阴性乳腺癌（52%比 17%；P=0.006）。在手术组患者中，95%接受了术前全身治疗。全身治疗的临床疗效差异显著，手术组患者更有可能获得缓解或稳定的疾病（54%比 25%；P=0.04）。根治性手术切除相关并发症发生率为 25%。对于激素受体阳性的复发患者，手术组患者的 5 年无进展生存率显著更高（46.3%比 14.5%；P=0.01）。
在孤立性 SCW 复发患者中，激素受体阳性复发与生存改善相关。全身治疗应作为初始治疗，临床疗效可用于帮助选择可能从根治性切除中获益的患者。
