Department of Surgery, New Victoria Hospital, Glasgow, UK; Department of Academic Surgery, University of Glasgow, UK.
Department of Surgery, Ninewells Hospital, Dundee, UK.
Eur J Surg Oncol. 2018 Jul;44(7):939-944. doi: 10.1016/j.ejso.2018.04.004. Epub 2018 Apr 13.
Current evidence for oncoplastic breast conservation (OBC) is based on single institutional series. Therefore, we carried out a population-based audit of OBC practice and outcomes in Scotland.
A predefined database of patients treated with OBC was completed retrospectively in all breast units practicing OBC in Scotland.
589 patients were included from 11 units. Patients were diagnosed between September 2005 and March 2017. High volume units performed a mean of 19.3 OBCs per year vs. low volume units who did 11.1 (p = 0.012). 23 different surgical techniques were used. High volume units offered a wider range of techniques (8-14) than low volume units (3-6) (p = 0.004). OBC was carried out as a joint operation involving a breast and a plastic surgeon in 389 patients. Immediate contralateral symmetrisation rate was significantly higher when OBC was performed as a joint operation (70.7% vs. not joint operations: 29.8%; p < 0.001). The incomplete excision rate was 10.4% and was significantly higher after surgery for invasive lobular carcinoma (18.9%; p = 0.0292), but was significantly lower after neoadjuvant chemotherapy (3%; p = 0.031). 9.2% of patients developed major complications requiring hospital admission. Overall the complication rate was significantly lower after neoadjuvant chemotherapy (p = 0.035). The 5 year local recurrence rate was 2.7%, which was higher after OBC for DCIS (8.3%) than invasive ductal cancer (1.6%; p = 0.026). 5-year disease-free survival was 91.7%, overall survival was 93.8%, and cancer-specific survival was 96.1%.
This study demonstrated that measured outcomes of OBC in a population-based multi-centre setting can be comparable to the outcomes of large volume single centre series.
目前关于肿瘤整形保乳术（oncoplastic breast conservation，OBC）的证据基于单机构系列研究。因此，我们在苏格兰开展了一项基于人群的 OBC 实践和结果的审计。
在所有行 OBC 的乳腺单位中，回顾性地完成了一份预先设定的 OBC 患者数据库。
从 11 个单位纳入 589 例患者。患者于 2005 年 9 月至 2017 年 3 月间确诊。高容量单位每年平均开展 19.3 例 OBC，而低容量单位每年开展 11.1 例（p=0.012）。共使用了 23 种不同的手术技术。高容量单位提供了更广泛的技术范围（8-14 种），而低容量单位（3-6 种）（p=0.004）。在 389 例患者中，OBC 是由乳腺和整形外科医生共同进行的联合手术。OBC 作为联合手术进行时，即刻对侧对称率显著更高（70.7%比非联合手术：29.8%；p<0.001）。不完全切除率为 10.4%，在浸润性小叶癌手术后显著更高（18.9%；p=0.0292），但在新辅助化疗后显著更低（3%；p=0.031）。9.2%的患者发生需要住院治疗的重大并发症。总体而言，新辅助化疗后并发症发生率显著更低（p=0.035）。5 年局部复发率为 2.7%，OBC 治疗 DCIS（8.3%）后的复发率高于浸润性导管癌（1.6%；p=0.026）。5 年无病生存率为 91.7%，总生存率为 93.8%，癌症特异性生存率为 96.1%。
本研究表明，在基于人群的多中心环境中测量的 OBC 结果可与大样本量单中心系列研究的结果相媲美。
