Viot Julien, Bachour Martin, Meurisse Aurélia, Pivot Xavier, Fiteni Frédéric
University Hospital of Besançon, Department of Medical Oncology, France.
Bregille Reeducation Center, Besançon, France.
Breast. 2017 Aug;34:53-57. doi: 10.1016/j.breast.2017.05.005. Epub 2017 May 12.
We conducted a retrospective study to assess the follow-up of patients with localized breast cancer and the first indicators of advanced breast cancer recurrence. All patients with advanced breast cancer recurrence treated between January 2010 and June 2016 in our institution were registered. Among these patients, 303 patients initially treated for early breast cancer with curative intent were identified. After initial curative treatment, follow-up involved the oncologist, the general practitioner and the gynecologist in 68.0%, 48.9% and 19.1% of cases, respectively. The median DFI was 4 years for luminal A, 3.8 years for luminal B, 3.7 years for HER2-positive and 1.5 years for TNBC (p = 0.07). Breast cancer tumor marker was prescribed for 164 patients (54.1%). No difference in terms of follow-up was observed according to the molecular subtype. Symptoms were the primary indicator of relapse for 143 patients (47.2%). Breast cancer recurrence was discovered by CA 15.3 elevation in 57 patients (18.8%) and by CAE elevation in 3 patients (1%). The rate of relapse diagnosed by elevation of CA 15.3 or CAE was not statistically associated with the molecular subtype (p = 0.65). Luminal A cases showed a significantly higher rate of bone metastases (p = 0.0003). TNBC cases showed a significantly higher rate of local recurrence (p = 0.002) and a borderline statistical significant higher rate of lung/pleural metastases (p = 0.07). Follow-up recommendations could be adapted in clinical practice according to the molecular subtype. General practitioners should be more involved by the specialists in breast cancer follow-up.
我们开展了一项回顾性研究,以评估局部乳腺癌患者的随访情况以及晚期乳腺癌复发的首要指标。对2010年1月至2016年6月间在本机构接受治疗的所有晚期乳腺癌复发患者进行了登记。在这些患者中,确定了303例最初接受早期乳腺癌根治性治疗的患者。初始根治性治疗后,分别有68.0%、48.9%和19.1%的病例由肿瘤内科医生、全科医生和妇科医生参与随访。腔面A型的中位无病生存期为4年,腔面B型为3.8年,HER2阳性型为3.7年,三阴性乳腺癌为1.5年(p = 0.07)。164例患者(54.1%)接受了乳腺癌肿瘤标志物检测。根据分子亚型,在随访方面未观察到差异。症状是143例患者(47.2%)复发的主要指标。57例患者(18.8%)通过CA 15.3升高发现乳腺癌复发,3例患者(1%)通过癌胚抗原升高发现复发。CA 15.3或癌胚抗原升高诊断的复发率与分子亚型无统计学关联(p = 0.65)。腔面A型病例的骨转移率显著更高(p = 0.0003)。三阴性乳腺癌病例的局部复发率显著更高(p = 0.002),肺/胸膜转移率有接近统计学意义的更高(p = 0.07)。在临床实践中,可根据分子亚型调整随访建议。乳腺癌随访中,专科医生应让全科医生更多地参与进来。