Department of Surgery, Erasmus MC Cancer Institute, Postbus 5201, 3008 AE Rotterdam, The Netherlands.
Department of Medical Oncology, Erasmus MC Cancer Institute, Postbus 5201, 3008 AE Rotterdam, The Netherlands.
Eur J Cancer. 2015 Feb;51(3):282-91. doi: 10.1016/j.ejca.2014.12.003. Epub 2014 Dec 27.
To investigate the overall survival of invasive breast cancer patients with primary breast conserving surgery (BCS) followed by re-excision compared to those with primary BCS only. The Dutch re-excision indications are less stringent compared to other European and Northern American countries (Society of Surgical Oncology-American Society for Radiation Oncology (SSO/ASTRO) guideline).
Retrospective analyses in women <75years with breast cancer stage pT1-T3 treated by BCS and radiotherapy between 1999 and 2012 from a population-based database. The national guideline recommends to reserve re-excision for invasive tumours showing 'more than focally positive' margin since 2002. Patients were divided into 'primary BCS only', 're-excision by BCS', and 're-excision by mastectomy'. Multivariable Cox regression analysis was adjusted for patient and systemic treatment characteristics.
A total of 11,695 patients were included of which 2156 (18.4%) underwent re-excision. Median time of follow-up was 61months (interquartile range (IQR) 26-101). The 5-year overall survival rates in the 'primary BCS only', 're-excision by BCS' and 're-excision by mastectomy' group were 92%, 95% and 91%, respectively. The 10-year overall survival rates were 81%, 82% and 79%, respectively (P=0.20). After multivariable analyses no significant association was observed between use of and type of re-excision and overall survival.
The overall survival of breast cancer patients with a re-excision did not significantly differ from the survival of women who underwent primary BCS only. Advising re-excision only for those tumours showing 'more than focally positive' resection margin appears safe, supposing the long-term safety of the recent SSO/ASTRO guideline that more cautiously recommended re-excision for tumours showing 'ink on tumour'.
研究与仅行原发性保乳手术（BCS）相比，行原发性 BCS 后再次切除术的浸润性乳腺癌患者的总生存率。与其他欧洲和北美国家相比，荷兰的再次切除术指征不那么严格（外科肿瘤学会-放射肿瘤学会（SSO/ASTRO）指南）。
对 1999 年至 2012 年间在人群基础数据库中接受 BCS 和放疗的 <75 岁乳腺癌 pT1-T3 期女性进行回顾性分析。国家指南建议自 2002 年以来，仅对显示“多处阳性”切缘的浸润性肿瘤保留再次切除术。患者分为“仅行原发性 BCS”、“BCS 再次切除术”和“乳房切除术再次切除术”。多变量 Cox 回归分析调整了患者和全身治疗特征。
共纳入 11695 例患者，其中 2156 例（18.4%）接受了再次切除术。中位随访时间为 61 个月（四分位距（IQR）26-101）。“仅行原发性 BCS”、“BCS 再次切除术”和“乳房切除术再次切除术”组的 5 年总生存率分别为 92%、95%和 91%。10 年总生存率分别为 81%、82%和 79%（P=0.20）。多变量分析后，再次切除术的使用和类型与总生存率之间无显著关联。
行再次切除术的乳腺癌患者的总体生存率与仅行原发性 BCS 的患者的生存率无显著差异。假设最近 SSO/ASTRO 指南建议更谨慎地对显示“肿瘤内墨水”的肿瘤进行再次切除术的长期安全性，那么仅对显示“多处阳性”切除边缘的肿瘤建议再次切除术是安全的。
