Dieterich M, Dieterich H, Moch H, Rosso C
Universitätsfrauenklinik und Poliklinik, University of Rostock, Rostock.
Breast Center Rheinfelden, Rheinfelden.
Geburtshilfe Frauenheilkd. 2012 Nov;72(11):1018-1023. doi: 10.1055/s-0032-1327980.
Controversy continues over the impact of re-excision (RE) on local recurrence (LR) in patients with invasive breast cancer. We investigated factors which could effect RE rates in patients undergoing breast-conserving or oncoplastic surgery. Between 2000 and 2003, 489 patients with stage pT1-pT2 or pN0/1 tumors were evaluated. 74 patients fulfilled the inclusion criteria. Patients were categorized into 3 groups: no RE (n = 25), RE during primary surgery (n = 28), and RE performed during secondary or even tertiary procedure (n = 21). All tumor slides were re-evaluated by a pathologist specializing in breast cancer. Mean follow-up was 70 months with an overall LR rate of 4.1 %. Binary logistic regression revealed no tumor-specific risk factors for RE. There was no LR in the group of patients who did not have RE. There was one case of LR in the group of patients who had RE during primary surgery. Two cases of LR were observed in the group of patients who had two or more surgical procedures. New risk factors for increased RE rates were not observed, reflecting the inconsistent data on risk factors for RE. However, breast cancers should be excised in a single procedure and oncoplastic procedures should be considered.
对于再次切除(RE)对浸润性乳腺癌患者局部复发(LR)的影响,争议仍在继续。我们调查了可能影响接受保乳手术或肿瘤整形手术患者再次切除率的因素。在2000年至2003年期间,对489例pT1 - pT2期或pN0/1期肿瘤患者进行了评估。74例患者符合纳入标准。患者被分为3组:未进行再次切除(n = 25)、初次手术时进行再次切除(n = 28)以及在二次或甚至三次手术时进行再次切除(n = 21)。所有肿瘤切片均由一位乳腺癌专科病理学家重新评估。平均随访70个月,总体局部复发率为4.1%。二元逻辑回归显示没有再次切除的肿瘤特异性危险因素。未进行再次切除的患者组中没有局部复发。初次手术时进行再次切除的患者组中有1例局部复发。在接受两次或更多次手术的患者组中观察到2例局部复发。未观察到再次切除率增加的新危险因素,这反映了关于再次切除危险因素的数据不一致。然而,乳腺癌应在一次手术中切除,并应考虑肿瘤整形手术。