Locker A P, Ellis I O, Morgan D A, Elston C W, Mitchell A, Blamey R W
Department of Surgery, City Hospital, Nottingham, UK.
Br J Surg. 1989 Sep;76(9):890-4. doi: 10.1002/bjs.1800760906.
Between November 1979 and December 1986, 263 patients were treated for primary breast cancer by local excision and radiotherapy at the City Hospital, Nottingham. Local recurrence within the treated breast occurred in 56 patients (21 per cent), in 18 (6.8 per cent) of whom it was gross and uncontrollable. An analysis of clinicopathological features shows patient age, nodal status, tumour size, presence of definitive vascular invasion, adjacent ductal carcinoma in situ and grade to be predictive of local recurrence. A Cox's multivariate analysis of these factors shows the first four to be independently significant. The factors can be combined as a prognostic index which allows identification of patients at high risk of local recurrence. On the basis of these findings we have altered our selection policy for patients suitable for breast conservation.
1979年11月至1986年12月期间，263例原发性乳腺癌患者在诺丁汉市立医院接受了局部切除和放射治疗。接受治疗的乳房出现局部复发的有56例（21%），其中18例（6.8%）为肉眼可见且无法控制的复发。对临床病理特征的分析表明，患者年龄、淋巴结状态、肿瘤大小、明确的血管侵犯、相邻原位导管癌以及分级可预测局部复发。对这些因素进行的Cox多变量分析显示，前四项因素具有独立的显著性。这些因素可合并为一个预后指数，用于识别有局部复发高风险的患者。基于这些发现，我们改变了对适合保乳治疗患者的选择策略。
