Recht A, Connolly J L, Schnitt S J, Silver B, Rose M A, Love S, Harris J R
Department of Radiation Therapy, Harvard Medical School, Boston, MA 02115.
Int J Radiat Oncol Biol Phys. 1988 Jan;14(1):3-10. doi: 10.1016/0360-3016(88)90043-0.
Prognostic factors for local recurrence following conservative surgery and radiation therapy for patients with early breast cancer have not been fully established. To evaluate the importance of young age as a prognostic factor for local recurrence, we reviewed the results of treatment of 597 patients with 607 UICC-AJCC Stage I or II breast cancers, 47 of which were diagnosed when the patient was less than 35 years old. All were treated with excisional biopsy and a total dose to the site of the primary tumor of 60 Gy or more. The median follow-up in survivors was 63 months. Patient age and the presence of an extensive intraductal component (EIC) were both highly associated with the likelihood of tumor recurrence in the treated breast. Patients under 35 had an actuarial 5-year recurrence rate of 26%, compared to 10% for older patients (p = 0.002). Patients with an EIC had a breast recurrence rate of 25%, compared to 5% when EIC was absent (p less than 0.0001). Although the incidence of an EIC was higher in the younger subgroup (44% vs. 31%), this alone did not account for the difference in in breast recurrence rates, since younger patients had a higher recurrence rate than older patients even when an EIC was absent (22% vs. 3%, p = 0.0003). We conclude that the age of the patient is an important prognostic factor for local recurrence following conservative surgery and radiation therapy. This finding is in part attributed to the observation that younger women are more likely to have tumors with an EIC than older women, but even when an EIC is absent, they may be at an increased risk of local recurrence. However, caution is required in interpreting these findings with regard to selecting among treatment options until further data are available comparing the results of conservative surgery and radiation therapy to those of mastectomy in younger patients.
早期乳腺癌患者接受保乳手术和放射治疗后局部复发的预后因素尚未完全明确。为评估年轻作为局部复发预后因素的重要性，我们回顾了597例患有607例UICC-AJCC I期或II期乳腺癌患者的治疗结果，其中47例患者诊断时年龄小于35岁。所有患者均接受了切除活检，原发肿瘤部位的总剂量为60 Gy或更高。幸存者的中位随访时间为63个月。患者年龄和广泛导管内成分（EIC）的存在均与治疗乳腺中肿瘤复发的可能性高度相关。35岁以下患者的5年精算复发率为26%，而老年患者为10%（p = 0.002）。有EIC的患者乳腺复发率为25%，无EIC时为5%（p小于0.0001）。尽管年轻亚组中EIC的发生率较高（44%对31%），但仅此一点并不能解释乳腺复发率的差异，因为即使没有EIC，年轻患者的复发率也高于老年患者（22%对3%，p = 0.0003）。我们得出结论，患者年龄是保乳手术和放射治疗后局部复发的重要预后因素。这一发现部分归因于观察到年轻女性比老年女性更有可能患有伴有EIC的肿瘤，但即使没有EIC，她们局部复发的风险可能也会增加。然而，在有更多数据比较年轻患者保乳手术和放射治疗与乳房切除术的结果之前，在解释这些结果以选择治疗方案时需要谨慎。
