Warren Laura E G, Guo Hao, Regan Meredith M, Nakhlis Faina, Yeh Eren D, Jacene Heather A, Hirshfield-Bartek Judi, Overmoyer Beth A, Bellon Jennifer R
Harvard Radiation Oncology Program, Boston, MA, USA.
Ann Surg Oncol. 2015 Aug;22(8):2483-91. doi: 10.1245/s10434-015-4469-4. Epub 2015 Mar 20.
Inflammatory breast cancer (IBC) is a rare and aggressive subtype. This study analyzes the patterns of failure in patients with IBC treated at our institution.
We retrospectively analyzed the records of 227 women with IBC presenting between 1997 and 2011. Survival analysis was used to calculate overall survival (OS) and disease-free survival. Competing risk analysis was used to calculate locoregional recurrence (LRR).
A total of 173 patients had locoregional-only disease at presentation (non-MET). Median follow-up in the surviving patients was 3.3 years. Overall, 132 (76.3 %) patients received trimodality therapy with chemotherapy, surgery, and radiotherapy. Three-year OS was 73.1 % [95 % confidence interval (CI) 64.9-82.4]. Cumulative LRR was 10.1, 16.9, and 21.3 % at 1, 2, and 3 years, respectively. No variable was significantly associated with LRR. Fifty-four patients had metastatic disease at presentation (MET). Median follow-up in the surviving patients was 2.6 years. Three-year OS was 44.3 % (95 % CI 31.4-62.5). Twenty-four (44.4 %) patients received non-palliative local therapy (radiotherapy and/or surgery). For these patients, median OS after local therapy was 2 years. Excluding six patients who received local therapy for symptom palliation, the crude incidence of locoregional progression or recurrence (LRPR) was 17 % (4/24) for those who received local therapy compared with 57 % (13/23) for those who did not.
For non-MET patients, LRR remains a problem despite trimodality therapy. More aggressive treatment is warranted. For MET patients, nearly 60 % have LRPR with systemic therapy alone. Local therapy should be considered in the setting of metastatic disease to prevent potential morbidity of progressive local disease.
炎性乳腺癌（IBC）是一种罕见且侵袭性强的亚型。本研究分析了在我院接受治疗的IBC患者的失败模式。
我们回顾性分析了1997年至2011年间就诊的227例IBC女性患者的记录。采用生存分析计算总生存期（OS）和无病生存期。采用竞争风险分析计算局部区域复发（LRR）。
共有173例患者初诊时仅为局部区域疾病（非转移）。存活患者的中位随访时间为3.3年。总体而言，132例（76.3%）患者接受了化疗、手术和放疗的三联疗法。三年总生存率为73.1%[95%置信区间（CI）64.9 - 82.4]。1年、2年和3年的累积局部区域复发率分别为10.1%、16.9%和21.3%。没有变量与局部区域复发显著相关。54例患者初诊时已有转移性疾病（转移）。存活患者的中位随访时间为2.6年。三年总生存率为44.3%（95%CI 31.4 - 62.5）。24例（44.4%）患者接受了非姑息性局部治疗（放疗和/或手术）。对于这些患者，局部治疗后的中位总生存期为2年。排除6例因症状缓解而接受局部治疗的患者，接受局部治疗的患者局部区域进展或复发（LRPR）的粗发病率为17%（4/24），而未接受局部治疗的患者为57%（13/23）。
对于非转移患者，尽管采用了三联疗法，局部区域复发仍然是一个问题。需要更积极的治疗。对于转移患者，近60%的患者仅接受全身治疗时会出现局部区域进展或复发。在转移性疾病的情况下应考虑局部治疗，以预防局部疾病进展的潜在发病率。
