Laboratory of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan Campus Cascina Rosa, Fondazione IRCCS Istituto Nazionale Tumori, via Vanzetti 5, 20133, Milan, Italy.
Department of Oncology, Haukeland University Hospital, N 5021, Bergen, Norway.
Breast Cancer Res. 2019 May 2;21(1):57. doi: 10.1186/s13058-019-1139-7.
The aim of the research was to separate the distant metastasis (DM) enhancing effect due to breast tumour removal from that due to surgical manoeuvre by itself.
DM dynamics following surgery for ipsilateral breast tumour recurrence (IBTR), contralateral breast cancer (CBC) and delayed reconstruction (REC), which was performed after the original breast cancer surgical removal, was analysed. A total of 338 patients with IBTR, 239 with CBC and 312 with REC were studied.
The DM dynamics following IBTR, CBC and REC, when assessed with time origin at their surgical treatment, is similar to the analogous pattern following primary tumour removal, with a first major peak at about 18 months and a second lower one at about 5 years from surgery. The time span between primary tumour removal and the second surgery is influential on DM risk levels for IBTR and CBC patients, not for REC patients.
The role of breast tumour removal is different from the role of surgery by itself. Our findings suggest that the major effect of reconstructive surgery is microscopic metastasis acceleration, while breast tumour surgical removal (either primary or IBTR or CBC) involves both tumour homeostasis interruption and microscopic metastasis growth acceleration. The removal of a breast tumour would eliminate its homeostatic restrains on metastatic foci, thus allowing metastasis development, which, in turn, would be supported by the forwarding action of the mechanisms triggered by the surgical wounding.
本研究旨在将因乳房肿瘤切除而导致的远处转移（DM）增强作用与手术本身的作用区分开来。
分析了同侧乳房肿瘤复发（IBTR）、对侧乳腺癌（CBC）和延迟重建（REC）手术后的 DM 动态，其中 REC 是在原发乳腺癌手术后进行的。共研究了 338 例 IBTR、239 例 CBC 和 312 例 REC 患者。
以手术治疗为时间起点，IBTR、CBC 和 REC 后的 DM 动态与原发肿瘤切除后的类似模式相似，第一个主要高峰出现在手术后约 18 个月，第二个较低高峰出现在手术后约 5 年。原发肿瘤切除和第二次手术之间的时间间隔对 IBTR 和 CBC 患者的 DM 风险水平有影响，但对 REC 患者没有影响。
乳房肿瘤切除的作用不同于手术本身的作用。我们的发现表明，重建手术的主要作用是加速微观转移，而乳房肿瘤的手术切除（无论是原发性、IBTR 还是 CBC）都涉及肿瘤内稳态的中断和微观转移生长的加速。切除一个乳房肿瘤将消除其对转移灶的内稳态限制，从而允许转移的发展，而这反过来又会受到手术创伤引发的机制的推动作用的支持。
