Lindley R, Bulman A, Parsons P, Phillips R, Henry K, Ellis H
Department of Surgery, Westminster Hospital, London, England.
Surgery. 1989 Jan;105(1):13-20.
A histopathologic review was undertaken of 293 patients with breast cancer treated by local tumor excision and radical radiotherapy. In a 6-year period, there were 37 local treatment failures with 16 deaths, and an additional 20 patients died without local recurrence. Pathologic data were available for 272 patients. Multivariate analysis indicated that the pathologic features in an invasive tumor most predictive for local recurrence were the combination of a high proportion of intraduct carcinoma with extensive necrosis (comedocarcinoma). Of 18 patients with these features, nine have had early local recurrence (a risk of 50% with these features vs 10% in those without), and four have died (a risk of 22% against 12%). Despite the short follow-up, the results already appear significant, and the study is ongoing. The importance of comedonecrosis in the intraduct component as a prognostic indicator in invasive carcinoma of the breast is not widely recognized and might constitute a relative contraindication to conservative treatment of the breast.
对293例接受局部肿瘤切除及根治性放疗的乳腺癌患者进行了组织病理学回顾。在6年期间，有37例局部治疗失败，其中16例死亡，另外20例患者未出现局部复发但死亡。272例患者有病理数据。多因素分析表明，浸润性肿瘤中最能预测局部复发的病理特征是高比例的导管内癌合并广泛坏死（粉刺癌）。在具有这些特征的18例患者中，9例出现早期局部复发（这些特征的风险为50%，无这些特征的患者为10%），4例死亡（风险为22%，而无这些特征的患者为12%）。尽管随访时间较短，但结果已显示出显著性，研究仍在进行中。导管内成分的粉刺样坏死作为乳腺浸润性癌的预后指标的重要性尚未得到广泛认可，可能构成乳腺癌保守治疗的相对禁忌证。
