Braunstein Lior Z, Niemierko Andrzej, Shenouda Mina N, Truong Linh, Sadek Betro T, Abi Raad Rita, Wong Julia S, Punglia Rinaa S, Taghian Alphonse G, Bellon Jennifer R
Harvard Radiation Oncology Program, Boston, Massachusetts.
Breast J. 2015 Mar-Apr;21(2):161-7. doi: 10.1111/tbj.12371. Epub 2015 Jan 6.
Local-regional recurrence (LRR) after breast-conserving therapy (BCT) can result in distant metastasis and decreased disease-free survival (DFS). This study examines factors associated with DFS following LRR. The initial population included 2,233 consecutive women who underwent BCT from 1998 to 2007. Biologic subtype was approximated using a combination of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and tumor grade. Cumulative incidence of DFS after LRR was calculated. The association of clinical, pathologic, and treatment parameters with DFS was evaluated using a Cox regression model. At a median follow-up of 105 months, 82 patients (3.7%) had a LRR. Of these, 66 (80%) were in-breast and 16 (20%) involved the ipsilateral lymph nodes. Twenty patients subsequently developed distant metastases. Five-year DFS after initial recurrence was 69.6% for the overall cohort. On univariate analysis, triple-negative disease (ER/PR/HER2 negative, TNBC) was associated with reduced DFS (HR = 3.8; 95% CI: 1.8-8.1; p < 0.001). Other factors associated with reduced DFS were larger tumor size (HR = 1.3; 95% CI: 1.03-1.6; p = 0.02), shorter interval from initial diagnosis to LRR (HR = 0.98 per month; 95% CI: 0.97-0.99; p = 0.02), and no salvage surgery (HR = 0.2; 95% CI: 0.09-0.5; p = 0.001). On multivariate analysis, TNBC remained the most significant factor associated with reduced DFS (HR = 4.8; 95% CI: 2.25-10.4; p < 0.001). Compared to women with luminal A disease, those with TNBC had significantly worse DFS (37.5% versus 88.3% at 5 years; p < 0.001). Women with TNBC who developed LRR were at high risk of subsequent recurrence. Efforts should be targeted toward both preventing initial recurrence and decreasing subsequent metastasis.
保乳治疗（BCT）后的局部区域复发（LRR）可导致远处转移并降低无病生存期（DFS）。本研究探讨LRR后与DFS相关的因素。初始队列包括1998年至2007年连续接受BCT的2233名女性。使用雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体2（HER2）和肿瘤分级的组合来近似生物亚型。计算LRR后DFS的累积发生率。使用Cox回归模型评估临床、病理和治疗参数与DFS的关联。在中位随访105个月时，82例患者（3.7%）发生LRR。其中，66例（80%）为乳腺内复发，16例（20%）累及同侧淋巴结。20例患者随后发生远处转移。整个队列初始复发后的5年DFS为69.6%。单因素分析显示，三阴性疾病（ER/PR/HER2阴性，TNBC）与DFS降低相关（HR = 3.8；95% CI：1.8 - 8.1；p < 0.001）。与DFS降低相关的其他因素包括肿瘤体积较大（HR = 1.3；95% CI：1.03 - 1.6；p = 0.02）、从初始诊断到LRR的间隔时间较短（HR = 0.98/月；95% CI：0.97 - 0.99；p = 0.02）以及未进行挽救性手术（HR = 0.2；95% CI：0.09 - 0.5；p = 0.001）。多因素分析显示，TNBC仍然是与DFS降低相关的最显著因素（HR = 4.8；95% CI：2.25 - 10.4；p < 0.001）。与管腔A型疾病的女性相比，TNBC女性的DFS明显更差（5年时为37.5%对88.3%；p < 0.001）。发生LRR的TNBC女性随后复发的风险很高。应致力于预防初始复发和减少随后的转移。
