Gosset Marie, Hamy Anne-Sophie, Mallon Peter, Delomenie Myriam, Mouttet Delphine, Pierga Jean-Yves, Lae Marick, Fourquet Alain, Rouzier Roman, Reyal Fabien, Feron Jean-Guillaume
Department of Surgery, Institut Curie, 75005, Paris, France.
Breast Unit, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AB, Northern Ireland.
PLoS One. 2016 Aug 5;11(8):e0159888. doi: 10.1371/journal.pone.0159888. eCollection 2016.
The poor prognosis of patients who experience ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery (BCS) is established. A short time between primary cancer and IBTR is a prognostic factor but no clinically relevant threshold was determined. Classification of IBTR may help tailor treatment strategies.
We determined a specific time frame, which differentiates IBTR into early and late recurrence, and identified prognostic factors for patients with IBTR at time of the recurrence.
We analyzed 2209 patients with IBTR after BCS. We applied the optimal cut-points method for survival data to determine the cut-off times to IBTR. A subgroup analysis was performed by hormone receptor (HR) status. Survival analyses were performed using a Cox proportional hazard model to determine clinical features associated with distant-disease-free survival (DDFS) after IBTR. We therefor built decision trees.
On the 828 metastatic events observed, the majority occurred within the first 3 months after IBTR: 157 in the HR positive group, 98 in the HR negative group. We found different prognostic times to IBTR: 49 months in the HR positive group, 33 in the HR negative group. After multivariate analysis, time to IBTR was the first discriminant prognostic factor in both groups (HR 0.65 CI95% [0.54-0.79] and 0.42 [0.30-0.57] respectively). The other following variables were significantly correlated with the DDFS: the initial number of positive lymph nodes for both groups, the initial tumor size and grade for HR positive tumors.
A short interval time to IBTR is the strongest factor of poor prognosis and reflects occult distant disease. It would appear that prognosis after IBTR depends more on clinical and histological parameters than on surgical treatment. A prospective trial in a low-risk group of patients to validate the safety of salvage BCS instead of mastectomy in IBTR is needed.
保乳手术（BCS）后同侧乳腺肿瘤复发（IBTR）患者的预后较差已得到证实。原发癌与IBTR之间的时间短是一个预后因素，但尚未确定临床相关阈值。IBTR的分类可能有助于制定治疗策略。
我们确定了一个特定的时间框架，将IBTR分为早期和晚期复发，并确定了复发时IBTR患者的预后因素。
我们分析了2209例BCS后发生IBTR的患者。我们应用生存数据的最佳切点法来确定IBTR的截止时间。按激素受体（HR）状态进行亚组分析。使用Cox比例风险模型进行生存分析，以确定与IBTR后无远处疾病生存（DDFS）相关的临床特征。因此，我们构建了决策树。
在观察到的828例转移事件中，大多数发生在IBTR后的前3个月内：HR阳性组157例，HR阴性组98例。我们发现了不同的IBTR预后时间：HR阳性组为49个月，HR阴性组为33个月。多变量分析后，IBTR时间是两组的首要判别预后因素（HR分别为0.65，CI95%[0.54 - 0.79]和0.42[0.30 - 0.57]）。其他以下变量与DDFS显著相关：两组的阳性淋巴结初始数量、HR阳性肿瘤的初始肿瘤大小和分级。
IBTR间隔时间短是预后不良的最强因素，反映了隐匿性远处疾病。似乎IBTR后的预后更多地取决于临床和组织学参数，而不是手术治疗。需要在低风险患者组中进行前瞻性试验，以验证在IBTR中挽救性BCS而非乳房切除术的安全性。
