Xu Amy J, DeSelm Carl J, Ho Alice Y, Gillespie Erin F, Braunstein Lior Z, Khan Atif J, McCormick Beryl, Powell Simon N, Cahlon Oren
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Adv Radiat Oncol. 2019 Mar 1;4(3):447-452. doi: 10.1016/j.adro.2019.02.004. eCollection 2019 Jul-Sep.
Internal mammary node recurrence after definitive breast cancer treatment is poorly characterized, with limited data to guide clinical management. The aim of this study was to analyze the outcomes of patients with recurrent breast cancer involving internal mammary nodes to understand their natural history and determine prognostic factors associated with improved overall survival.
We performed a retrospective analysis of 553 patients with recurrent breast cancer and identified 161 patients with radiographic evidence of locoregional recurrence as a first event. A total of 67 patients (42%) were identified with internal mammary involvement. Median follow-up times were 76 months from date of initial diagnosis and 30 months from date of recurrence.
Of the 67 patients identified with internal mammary node failures, 10 (15%) presented with isolated recurrence, 14 (21%) presented with other sites of locoregional disease, and 43 (64%) presented with concomitant distant metastases. Median overall survival was 2.5 years and significantly associated with extent of disease ( < .0001). On multivariable analysis, concomitant distant metastases, inflammatory breast cancer, and triple negative histologic type were associated with worse overall survival, whereas salvage radiation therapy was associated with improved overall survival. Among the 10 patients with isolated internal mammary node failures, median progression-free survival was 6.0 years and salvage therapy with surgery, radiation, and chemotherapy were associated with the best outcomes.
Patients with isolated internal mammary node recurrences achieved long-term survival with aggressive therapies, and salvage radiation therapy was associated with improved survival.
在乳腺癌根治性治疗后，内乳淋巴结复发的特征尚不明确，指导临床管理的数据有限。本研究的目的是分析复发性乳腺癌累及内乳淋巴结患者的预后，以了解其自然病程，并确定与总体生存率提高相关的预后因素。
我们对553例复发性乳腺癌患者进行了回顾性分析，确定161例有影像学证据显示局部区域复发为首发事件的患者。共有67例患者（42%）被确定有内乳受累。从初次诊断日期起的中位随访时间为76个月，从复发日期起为30个月。
在67例被确定有内乳淋巴结复发的患者中，10例（15%）表现为孤立性复发，14例（21%）表现为其他局部区域疾病部位，43例（64%）表现为同时伴有远处转移。中位总生存期为2.5年，与疾病范围显著相关（<0.0001）。多变量分析显示，同时伴有远处转移、炎性乳腺癌和三阴性组织学类型与较差的总生存期相关，而挽救性放疗与总生存期改善相关。在10例孤立性内乳淋巴结复发的患者中，中位无进展生存期为6.0年，手术、放疗和化疗联合的挽救性治疗效果最佳。
孤立性内乳淋巴结复发的患者通过积极治疗可实现长期生存，挽救性放疗与生存率提高相关。
