Kurtz J M, Amalric R, Brandone H, Ayme Y, Spitalier J M
Department of Surgery, Cancer Institute, Marseille, France.
Ann Surg. 1988 Mar;207(3):347-51. doi: 10.1097/00000658-198803000-00021.
A retrospective analysis was performed of 118 surgically treated mammary recurrences, occurring following primary conservative excision and radiation therapy for clinical Stages I and II breast cancer. Actuarial cancer-specific survival following salvage surgery was 72% at 5 years and 58% at 10 years. With a median followup of 7 years, further local-regional recurrences were observed in 20 of the 118 patients, many of whom could be treated by further surgery. Actuarial survival after recurrence was significantly influenced by initial clinical stage, as well as by the disease-free interval following primary therapy, but was similar for both premenopausal and postmenopausal patients and for patients treated by radical or breast-conserving salvage operations. For recurrences after the fifth year, actuarial survival following salvage surgery was 83% and 68% at 5 and 10 years, respectively. Survival for Stage I patients was favorable regardless of disease-free interval. It is concluded that recurrences in the breast following primary treatment with limited surgery and irradiation have a considerably more favorable prognosis than that of local failures after primary radical surgery. Suggestions for the management of these recurrences are presented.
对118例临床I期和II期乳腺癌患者在接受原发性保守性切除及放射治疗后发生的乳腺复发进行了回顾性分析，这些患者均接受了手术治疗。挽救性手术后的精算癌症特异性生存率在5年时为72%，在10年时为58%。中位随访7年，118例患者中有20例出现了局部区域复发，其中许多患者可通过进一步手术治疗。复发后的精算生存率受初始临床分期以及原发性治疗后的无病间期显著影响，但绝经前和绝经后患者以及接受根治性或保乳挽救性手术的患者的生存率相似。对于第5年后的复发，挽救性手术后的精算生存率在5年和10年时分别为83%和68%。无论无病间期如何，I期患者的生存率都较好。得出的结论是，与原发性根治性手术后的局部失败相比，采用有限手术和放疗进行原发性治疗后乳腺复发的预后要有利得多。本文还提出了对这些复发的处理建议。
