Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China.
J Breast Cancer. 2015 Mar;18(1):36-43. doi: 10.4048/jbc.2015.18.1.36. Epub 2015 Mar 27.
This study investigated the clinicopathological features of operable breast cancer lesions located in different hemispheres of the breast and determined related survival outcomes.
Data from 5,330 patients with invasive ductal carcinoma were retrospectively analyzed based on tumor location.
The median follow-up time was 68 months (range, 18-176 months). Patients with breast cancer located in the outer hemisphere of the breast had lesions with more advanced nodal stages and more frequently received adjuvant chemotherapy than patients with breast cancer in the inner hemisphere. The 5-year disease-free survival (DFS) rates of patients with tumors located in outer versus inner hemispheres were 81.5% and 77.0%, respectively (p=0.004); the overall survival (OS) rates were 90.7% and 88.8%, respectively (p<0.001). The association between tumor location and the 5-year DFS rate was most apparent in node-positive patients (73.1% vs. 65.8% for outer vs. inner hemisphere lesions, p<0.001) and in patients with primary tumors greater than 2 cm in diameter (78.2% vs. 72.3%, p=0.002). Multivariate analysis showed that tumor location was an independent predictor of DFS (hazard ratio [HR], 1.23; p=0.002) and OS (HR, 1.28; p=0.006). There were no significant differences in 5-year DFS or OS rates between patients with outer versus inner hemisphere tumors when internal mammary node irradiation was performed.
This study demonstrated that tumor location was an independent prognostic factor for operable breast cancer. Internal mammary node irradiation is recommended for patients with breast cancer of the inner hemisphere and positive axillary lymph nodes or large primary tumors.
本研究旨在探讨位于不同乳房半球的可手术乳腺癌病变的临床病理特征，并确定相关的生存结局。
回顾性分析了 5330 例浸润性导管癌患者的肿瘤位置数据。
中位随访时间为 68 个月（范围，18-176 个月）。与乳房内半球的乳腺癌患者相比，乳房外半球的乳腺癌患者的淋巴结分期更晚，更常接受辅助化疗。肿瘤位于外半球的患者的 5 年无病生存率（DFS）为 81.5%，而位于内半球的患者为 77.0%（p=0.004）；总生存率（OS）分别为 90.7%和 88.8%（p<0.001）。肿瘤位置与 5 年 DFS 率的关系在外淋巴结阳性患者中最为明显（外半球病变为 73.1%，内半球病变为 65.8%，p<0.001），在直径大于 2cm 的原发性肿瘤患者中也最为明显（外半球病变为 78.2%，内半球病变为 72.3%，p=0.002）。多变量分析显示，肿瘤位置是 DFS（危险比[HR]，1.23；p=0.002）和 OS（HR，1.28；p=0.006）的独立预测因素。当进行内乳淋巴结照射时，外半球与内半球肿瘤患者的 5 年 DFS 或 OS 率无显著差异。
本研究表明，肿瘤位置是可手术乳腺癌的独立预后因素。对于内半球乳腺癌伴腋窝淋巴结阳性或原发肿瘤较大的患者，建议进行内乳淋巴结照射。
