Division of Breast and Endocrine Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Breast Cancer. 2013 Dec;16(4):410-6. doi: 10.4048/jbc.2013.16.4.410. Epub 2013 Dec 31.
This study compared the survival outcomes of different treatment methods for the ipsilateral breast of occult breast cancer (OBC) patients with axillary lymph node metastasis.
A retrospective study was conducted in which forty OBC patients with axillary lymph node metastasis were identified out of 15,029 patients who had been diagnosed with a primary breast cancer at between 1992 and 2010. The patients were categorized into three treatment groups based on ipsilateral breast management: breast-conserving surgery (BCS) (n=17), mastectomy (n=12), and nonsurgical intervention with or without radiation therapy (No surgery with or without radiation therapy [No Op±RT]) (n=11). All patients underwent axillary lymph node dissection. Cases were evaluated based on treatment and potential prognostic factors with respect to overall survival (OS) and disease-free survival (DFS).
During the follow-up period (median follow-up of 71.5 months), the overall OS and DFS were 76.9% and 74.9%, respectively. The 5-year treatment-specific OS was 72.0% for the BCS group, 74.0% for the mastectomy group, and 87.5% for the No Op±RT group (log-rank p=0.49). The 5-year DFS was 70.6% for the BCS group, 66.7% for the mastectomy group, and 90.9% for the No Op±RT group (log-rank p=0.36). Recurrence rates for the BCS and No Op±RT groups were 5.9% and 18.2%, respectively. Histologic grade and lymph node status were inversely correlated with DFS (log-rank p=0.04 and p<0.01, respectively).
There was no difference in survival outcomes between the three treatment methods for the ipsilateral breast (mastectomy, BCS, and No Op±RT) of OBC patients with axillary lymph node metastasis. A large-scale multicenter study is needed to validate the results from this small retrospective study.
本研究比较了隐匿性乳腺癌（OBC）伴腋窝淋巴结转移患者不同同侧乳房治疗方法的生存结局。
回顾性研究，1992 年至 2010 年间，共诊断出 15029 例原发性乳腺癌患者，其中 40 例为伴腋窝淋巴结转移的 OBC 患者。根据同侧乳房管理将患者分为三组：保乳手术（BCS）组（n=17）、乳房切除术组（n=12）和非手术治疗加或不加放疗组（No 手术加或不加放疗组 [NoOp±RT]）（n=11）。所有患者均接受腋窝淋巴结清扫术。根据治疗和潜在预后因素评估病例的总生存率（OS）和无病生存率（DFS）。
在随访期间（中位随访 71.5 个月），OS 和 DFS 分别为 76.9%和 74.9%。BCS 组、乳房切除术组和 NoOp±RT 组的 5 年治疗特异性 OS 分别为 72.0%、74.0%和 87.5%（对数秩检验，p=0.49）。BCS 组、乳房切除术组和 NoOp±RT 组的 5 年 DFS 分别为 70.6%、66.7%和 90.9%（对数秩检验，p=0.36）。BCS 组和 NoOp±RT 组的复发率分别为 5.9%和 18.2%。组织学分级和淋巴结状态与 DFS 呈负相关（对数秩检验，p=0.04 和 p<0.01）。
对于伴有腋窝淋巴结转移的 OBC 患者的同侧乳房（乳房切除术、BCS 和 NoOp±RT），三种治疗方法的生存结局无差异。需要进行大规模多中心研究来验证本小型回顾性研究的结果。
