Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA; Statistics Section, Massachusetts General Hospital, Boston, MA.
Clin Breast Cancer. 2014 Jun;14(3):198-204. doi: 10.1016/j.clbc.2013.12.007. Epub 2013 Dec 27.
This study assessed the clinical outcome and prognostic factors in patients with breast cancer who presented with isolated locoregional recurrence (ILRR) as a first event.
Between 1970 and 2008, 2960 patients with pT1-2, N0-3, M0 primary invasive breast cancer had either breast-conserving therapy (BCT) using lumpectomy and radiation therapy (RT) (group A = 1849 patients) or mastectomy without RT (group B = 1111 patients). Out of groups A and B, 117 and 103 patients, respectively, developed ILRR as a first event. Those 220 patients served as the basis for this study. A multivariate analysis was performed to estimate the clinical outcome of both groups, taking into account clinically relevant variables for the primary tumor and ILRR.
The median follow-up after ILRR was 83 months. The median disease-free interval (DFI) was 79 and 38 months for groups A and B, respectively. The overall survival (OS) for group A was 81% and 69% at 5 and 8 years, respectively. For group B, it was 61% and 46%, respectively. The distant metastasis-free survival (DMFS) for group A was 84% at 5 years and remained 84% at 8 years. The DMFS for group B was 60% at 5 years and 52% at 8 years. In multivariate analysis, initial local treatment (BCT vs. mastectomy without RT), pathologic T stage, locoregional recurrence site (local vs. regional), and DFI (≤ 4 years vs. > 4 years) were significant prognostic variables for both OS and DMFS.
Patients with breast cancer who developed ILRR after BCT as their initial local treatment have better clinical outcome compared with those who had mastectomy without RT.
本研究评估了以孤立局部区域复发（ILRR）为首发事件的乳腺癌患者的临床结局和预后因素。
1970 年至 2008 年间，2960 例 pT1-2、N0-3、M0 原发性浸润性乳腺癌患者接受保乳治疗（BCT），采用乳房切除术加放射治疗（RT）（A 组=1849 例）或乳房切除术而不接受 RT（B 组=1111 例）。A 组和 B 组中分别有 117 例和 103 例患者首次发生 ILRR。这 220 例患者为本研究的基础。进行了多变量分析，以评估两组的临床结局，同时考虑到原发性肿瘤和 ILRR 的临床相关变量。
ILRR 后中位随访时间为 83 个月。A 组和 B 组的中位无病间隔（DFI）分别为 79 和 38 个月。A 组的总生存率（OS）分别为 81%和 69%，5 年和 8 年时。B 组分别为 61%和 46%。A 组的远处无复发生存率（DMFS）为 5 年时为 84%，8 年时仍为 84%。B 组的 5 年 DMFS 为 60%，8 年时为 52%。多变量分析显示，初始局部治疗（BCT 与不接受 RT 的乳房切除术）、病理 T 分期、局部区域复发部位（局部与区域）和 DFI（≤4 年与>4 年）是 OS 和 DMFS 的显著预后因素。
BCT 作为初始局部治疗后发生 ILRR 的乳腺癌患者的临床结局优于未接受 RT 的乳房切除术患者。
