Kent Collin, Horton Janet, Blitzblau Rachel, Koontz Bridget F
Duke University School of Medicine, Durham, NC.
Duke University School of Medicine, Durham, NC; Duke Cancer Institute, Durham, NC.
Clin Breast Cancer. 2015 Dec;15(6):403-12. doi: 10.1016/j.clbc.2015.06.008. Epub 2015 Jun 19.
Effective local control is associated with improved overall survival, particularly for women with early-stage cancers. No other local therapy is typically offered to women with T1-2 N0 breast cancer after mastectomy, although in select women the 5-year local recurrence rate can be as high as 20%. Therefore, accurately predicting the women who are at highest risk for recurrence after mastectomy will identify those who might benefit from more aggressive adjuvant treatment. A systematic search was conducted identifying risk factors associated with locoregional recurrence, including age, menopausal status, receptor status, lymphovascular invasion (LVI), margin status, use of systemic therapy, size, grade, and genomic classifer score. Although associations varied among studies, the risk factors most consistently identified were age ≤ 40 years, LVI, positive/close margin, and larger tumor size. In women with multiple high risk factors, risk of local recurrence was as high as 20% at 10 years. Additional multicenter studies are needed to investigate risk factors for locoregional recurrence after mastectomy without radiotherapy in T1-2N0 breast cancer. Consideration of additional adjuvant local therapy might be warranted in a subset of women at high risk of local recurrence.
有效的局部控制与总体生存率的提高相关，尤其是对于早期癌症的女性。对于接受乳房切除术后的T1-2 N0期乳腺癌女性，通常不提供其他局部治疗，尽管在部分女性中，5年局部复发率可能高达20%。因此，准确预测乳房切除术后复发风险最高的女性，将有助于识别那些可能从更积极的辅助治疗中获益的患者。我们进行了一项系统检索，以确定与局部区域复发相关的危险因素，包括年龄、绝经状态、受体状态、淋巴管浸润（LVI）、切缘状态、全身治疗的使用、肿瘤大小、分级和基因组分类评分。尽管不同研究中的关联有所不同，但最一致确定的危险因素是年龄≤40岁、LVI、切缘阳性/切缘接近和肿瘤体积较大。在具有多个高危因素的女性中，10年局部复发风险高达20%。需要开展更多多中心研究，以调查T1-2N0期乳腺癌在未接受放疗的乳房切除术后局部区域复发的危险因素。对于局部复发高危的部分女性，可能有必要考虑额外的辅助局部治疗。
