Carrara Guilherme Freire Angotti, Scapulatempo-Neto Cristovam, Abrahão-Machado Lucas Faria, Brentani Maria Mitzi, Nunes João Soares, Folgueira Maria Aparecida Azevedo Koike, Vieira René Aloisio da Costa
Hospital de Câncer de Barretos, Programa de Pós-Graduação em Oncologia, Barretos/SP, Brazil.
Hospital de Câncer de Barretos, Departamento de Patologia, Barretos/SP, Brazil.
Clinics (Sao Paulo). 2017 Mar;72(3):134-142. doi: 10.6061/clinics/2017(03)02.
: To evaluate ipsilateral breast tumor recurrence after breast-conserving surgery for locally advanced breast cancer.
: A retrospective observational cohort study was performed in patients with locally advanced breast cancer submitted to breast-conserving surgery after neoadjuvant chemotherapy based on an adriamycin-cyclophosphamide-paclitaxel regimen. We evaluated the clinical, pathologic, immunohistochemistry, and surgical factors that contribute to ipsilateral breast tumor recurrence and locoregional recurrence. A Kaplan-Meier analysis and Cox model were used to evaluate the main factors related to disease-free survival.
: Of the 449 patients who received neoadjuvant chemotherapy, 98 underwent breast-conserving surgery. The average diameter of the tumors was 5.3 cm, and 87.2% reached a size of up to 3 cm. Moreover, 86.7% were classified as clinical stage III, 74.5% had T3-T4 tumors, 80.5% had N1-N2 axilla, and 89.8% had invasive ductal carcinoma. A pathologic complete response was observed in 27.6% of the tumors, and 100.0% of samples had free margins. The 5-year actuarial overall survival rate was 81.2%, and the mean follow-up was 72.8 months. The rates of ipsilateral breast tumor recurrence and locoregional recurrence were 11.2% and 15.3%, respectively. Multifocal morphology response was the only factor related to ipsilateral breast tumor recurrence disease-free survival (p=0.04). A multivariate analysis showed that the pathologic response evaluation criteria in solid tumors (RECIST)-breast cutoff was the only factor related to locoregional recurrence disease-free survival (p=0.01).
: Breast-conserving surgery is a safe and effective therapy for selected locally advanced breast tumors.
评估局部晚期乳腺癌保乳手术后同侧乳腺肿瘤复发情况。
对接受新辅助化疗后行保乳手术的局部晚期乳腺癌患者进行回顾性观察队列研究，新辅助化疗采用阿霉素 - 环磷酰胺 - 紫杉醇方案。我们评估了导致同侧乳腺肿瘤复发和局部区域复发的临床、病理、免疫组化及手术因素。采用Kaplan - Meier分析和Cox模型评估与无病生存相关的主要因素。
在449例接受新辅助化疗的患者中，98例行保乳手术。肿瘤平均直径为5.3 cm，87.2%的肿瘤最大径达3 cm。此外，86.7%被分类为临床III期，74.5%为T3 - T4期肿瘤，80.5%腋窝为N1 - N2，89.8%为浸润性导管癌。27.6%的肿瘤观察到病理完全缓解，100.0%的样本切缘阴性。5年精算总生存率为81.2%，平均随访72.8个月。同侧乳腺肿瘤复发率和局部区域复发率分别为11.2%和15.3%。多灶形态反应是与同侧乳腺肿瘤复发无病生存相关的唯一因素（p = 0.04）。多因素分析显示实体瘤（RECIST）-乳腺标准的病理反应评估标准是与局部区域复发无病生存相关的唯一因素（p = 0.01）。
保乳手术对于部分局部晚期乳腺肿瘤是一种安全有效的治疗方法。
