Jimbo Kenjiro, Kinoshita Takayuki, Asaga Sota, Hojo Takashi
Breast Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Surg Today. 2015 Oct;45(10):1255-62. doi: 10.1007/s00595-014-1052-8. Epub 2014 Oct 19.
The aim of this study was to retrospectively assess the oncological safety of breast-conserving surgery (BCS) after primary systemic chemotherapy (PST) in terms of local recurrence (LR) in cT3-4 patients.
The subjects were 146 cT1-2 patients who underwent BCS after PST, and 169 patients with cT3-4 primary breast cancer. Of the 169 patients with cT3-4 disease, 20 underwent surgery first, and 149 underwent surgery after PST (mastectomy: 101 patients; BCS: 48 patients). The LR-free survival (LRFS) was analyzed using a Kaplan-Meier analysis. We evaluated the predictors using Cox proportional hazards modeling for LR after PST.
There was no significant difference in 5-year LRFS between the cT1-2 and cT3-4 groups that underwent BCS after PST (98.6 vs. 92.5 %; P = 0.074). The 5-year LRFS was 94.7 % in the group that underwent initial surgery and 93.0 % in the PST group (P = 0.845) in the cT3-4 patients, while the 5-year LRFS rates were 93.2 % in the BCS subgroup and 92.5 % in the mastectomy subgroup (P = 0.958). In a multivariate analysis, the histological type, hormone negativity and a higher histological grade were independent predictors of LR after PST.
BCS after PST may be oncologically acceptable for cT3-4 breast cancers in terms of the LR compared with initial surgery or mastectomy after PST.
本研究旨在回顾性评估在cT3 - 4期患者中，原发性全身化疗（PST）后保乳手术（BCS）在局部复发（LR）方面的肿瘤学安全性。
研究对象为146例PST后接受BCS的cT1 - 2期患者，以及169例cT3 - 4期原发性乳腺癌患者。在169例cT3 - 4期疾病患者中，20例先接受手术，149例在PST后接受手术（乳房切除术：101例患者；BCS：48例患者）。采用Kaplan - Meier分析评估无局部复发生存期（LRFS）。我们使用Cox比例风险模型评估PST后LR的预测因素。
PST后接受BCS的cT1 - 2期和cT3 - 4期组之间的5年LRFS无显著差异（98.6%对92.5%；P = 0.074）。在cT3 - 4期患者中，初始手术组的5年LRFS为94.7%，PST组为93.0%（P = 0.845），而BCS亚组的5年LRFS率为93.2%，乳房切除亚组为92.5%（P = 0.958）。多因素分析中，组织学类型、激素阴性和较高的组织学分级是PST后LR的独立预测因素。
与PST后的初始手术或乳房切除术相比，就LR而言，PST后的BCS对于cT3 - 4期乳腺癌在肿瘤学上可能是可接受的。
