Breast Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy.
Breast Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Clin Breast Cancer. 2021 Aug;21(4):329-336. doi: 10.1016/j.clbc.2020.12.006. Epub 2020 Dec 17.
Salvage mastectomy is considered the treatment of choice for ipsilateral breast cancer recurrence (IBCR), even if a second breast-conserving surgery (BCS) is feasible. The purpose of this study was to describe the characteristics of IBCR patients, to compare the 2 therapeutic options in terms of long-term outcomes, and to identify independent factors that may predict the type of treatment.
A total of 309 IBCR patients who underwent either repeat BCS or mastectomy were identified. All the analyzed patients with IBCR had true recurrence.
Repeat BCS and salvage mastectomy were performed in 143 and 166 patients, respectively. Age < 65 years (59.6% vs 37.1% if age ≥ 65 years; odds ratio, 2.374; 95% confidence interval, 0.92-5.24; P = .018) and disease-free interval < 24 months (15.7% vs 10.5% if disease-free interval ≥ 24 months; odds ratio, 2.705; 95% confidence interval, 1.42-5.97; P = .007) were found to significantly increase the probability of receipt of mastectomy. Disease-free survival rates at 3, 5, and 10 years were 79.2%, 68.2%, and 36.9%; and 77.2%, 65.9%, and 55.3% in patients receiving repeat BCS or mastectomy, respectively (P = .842). Overall survival rates at 3, 5, and 10 years were 95.4%, 91.4%, and 68.5%; and 87.3%, 69.3%, and 57.9%, respectively, in patients receiving repeat BCS or mastectomy (P = .018).
Salvage mastectomy should not be considered the only treatment option for IBCR. A second BCS can still be evaluated and proposed to IBCR patients, with acceptable locoregional control and survival. The risk of poor long-term prognosis after mastectomy should be shared with the patient.
对于同侧乳腺癌复发（IBCR），即使可行二次保乳手术（BCS），挽救性乳房切除术也被认为是首选治疗方法。本研究的目的是描述 IBCR 患者的特征，比较两种治疗方法的长期结果，并确定可能预测治疗方式的独立因素。
共确定了 309 例接受再次 BCS 或乳房切除术的 IBCR 患者。所有 IBCR 患者均为真正复发。
分别有 143 例和 166 例患者接受了重复 BCS 和挽救性乳房切除术。年龄<65 岁（59.6% vs 年龄≥65 岁者的 37.1%；优势比，2.374；95%置信区间，0.92-5.24；P=0.018）和无病间期<24 个月（15.7% vs 无病间期≥24 个月者的 10.5%；优势比，2.705；95%置信区间，1.42-5.97；P=0.007）与接受乳房切除术的概率显著增加相关。接受重复 BCS 或乳房切除术的患者的无复发生存率分别为 3 年时 79.2%、5 年时 68.2%、10 年时 36.9%和 77.2%、65.9%、10 年时 55.3%（P=0.842）。接受重复 BCS 或乳房切除术的患者的总生存率分别为 3 年时 95.4%、5 年时 91.4%、10 年时 68.5%和 87.3%、69.3%、10 年时 57.9%（P=0.018）。
对于 IBCR，不应仅将挽救性乳房切除术视为唯一治疗选择。仍可对 IBCR 患者进行二次 BCS 评估并提出建议，局部区域控制和生存情况可接受。应与患者分享乳房切除术预后不良的风险。
