保乳手术后原位导管癌与浸润性乳腺癌同侧乳腺肿瘤复发情况的比较。
Comparison of ipsilateral breast tumor recurrence after breast-conserving surgery between ductal carcinoma in situ and invasive breast cancer.
作者信息
Choi Young Jin, Shin Young Duck, Song Young Jin
机构信息
Department of Surgery, Chungbuk National University School of Medicine, 410 Sungbong-ro, Heungdeok-gu, Cheongju, 361-763, South Korea.
Department of Anesthesiology, Chungbuk National University School of Medicine, 410 Sungbong-ro, Heungdeok-gu, Cheongju, 361-763, South Korea.
出版信息
World J Surg Oncol. 2016 Apr 27;14:126. doi: 10.1186/s12957-016-0885-6.
BACKGROUND
We aimed to evaluate the differences in the rates and predictive factors for ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) between ductal carcinoma in situ (DCIS) and invasive breast cancer. And, we evaluated the impact of IBTR on overall survival and distant metastasis.
METHODS
We retrospectively reviewed 322 consecutive patients with DCIS or invasive breast cancer who underwent BCS between 2004 and 2010. We evaluated the rates of IBTR of DCIS and invasive breast cancer. Univariate and multivariate analyses were performed to determine the predictive factors for IBTR, and survival rates were analyzed with Kaplan-Meier estimates.
RESULTS
With a median follow-up period of 57 months, 5 (10%) out of 50 DCIS patients and 14 (5.1%) out of 272 invasive cancer patients had developed IBTR. Factors associated with IBTR on univariate and multivariate analyses were positive resection margin status in DCIS and omission of radiotherapy in invasive cancer, respectively. The hormone receptor negativity was strong independent predictive factors for IBTR in both DCIS and invasive breast cancer. Although the differences of survival curve did not reach statistical significance, the 5-year overall survival and distant metastasis-free survival of invasive cancer patients who suffered IBTR were inferior to those without (84 vs. 98% and 63.3 vs. 96.5%, respectively). Advanced initial stage, lymph node metastasis and experience of IBTR were associated with poor overall survival and distant metastasis on univariate and multivariate analyses.
CONCLUSIONS
The hormone receptor negativity was revealed as independent predictive factor for IBTR after BCS in both DCIS and invasive cancer. Experience of IBTR was independent prognostic factor for poor overall outcome in patients with invasive breast cancer. Aggressive local control and adjuvant therapy should be made in hormone receptor-negative patients who receive treatment with BCS.
背景
我们旨在评估保乳手术（BCS）后导管原位癌（DCIS）和浸润性乳腺癌同侧乳腺肿瘤复发（IBTR）的发生率及预测因素的差异。并且，我们评估了IBTR对总生存和远处转移的影响。
方法
我们回顾性分析了2004年至2010年间连续接受BCS的322例DCIS或浸润性乳腺癌患者。我们评估了DCIS和浸润性乳腺癌的IBTR发生率。进行单因素和多因素分析以确定IBTR的预测因素，并用Kaplan-Meier估计法分析生存率。
结果
中位随访期为57个月，50例DCIS患者中有5例（10%）发生了IBTR，272例浸润性癌患者中有14例（5.1%）发生了IBTR。单因素和多因素分析中与IBTR相关的因素分别为DCIS的手术切缘阳性状态和浸润性癌未接受放疗。激素受体阴性在DCIS和浸润性乳腺癌中均是IBTR的强独立预测因素。尽管生存曲线的差异未达到统计学意义，但发生IBTR的浸润性癌患者的5年总生存率和无远处转移生存率低于未发生者（分别为84%对98%和63.3%对96.5%）。单因素和多因素分析显示，初始分期较晚、淋巴结转移和IBTR史与总生存和远处转移较差相关。
结论
激素受体阴性被揭示为DCIS和浸润性癌BCS后IBTR的独立预测因素。IBTR史是浸润性乳腺癌患者总体预后不良的独立预后因素。对于接受BCS治疗的激素受体阴性患者，应采取积极的局部控制和辅助治疗。
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