保乳治疗后患者的第二侵袭性乳腺癌。
Second invasive breast cancers in patients treated with breast-conserving therapy.
机构信息
Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China; Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China.
出版信息
Eur J Surg Oncol. 2021 Oct;47(10):2492-2498. doi: 10.1016/j.ejso.2021.06.013. Epub 2021 Jun 10.
OBJECTIVE
Second breast cancers after breast-conserving therapy (BCT) include ipsilateral breast tumor recurrence (IBTR) and metachronous contralateral breast cancer (CBC). Each IBTR is further classified as true recurrence (TR) or new primary tumor (NP). We aim to compare survival outcomes of TR, NP and CBC, and explore the optimal treatments.
METHODS
168,427 patients with primary breast cancer who underwent BCT between 1990 and 2005 were identified in the SEER database. The risks of IBTR and CBC were estimated by annual hazard rate. The breast cancer-specific survival (BCSS) were assessed using multivariable Cox regression analysis.
RESULTS
With median follow-up of 13 years after BCT, 5413 patients developed an IBTR and 4050 patients had a CBC. The risk of IBTR peaked between 10 and 15 years after BCT, while the risk of CBC distributed evenly. 45.9% of IBTRs were classified as a TR and 54.1% as an NP. The time interval from primary breast cancer to NP was longer than to TR and CBC (P < 0.001). Patients with TR had a poorer BCSS than NP (P = 0.003) and CBC (P = 0.002). There was no difference in BCSS between mastectomy and repeat BCT for treating TR (P = 0.584) or NP (P = 0.243). The BCSS of CBCs treated with BCT was better than mastectomy (P = 0.010). Chemotherapy didn't improve the survival of patients with TR (P = 0.058). However, TRs with grade III or negative hormone receptors benefited from chemotherapy significantly.
CONCLUSION
Patients with TR had a poorer BCSS than NP and CBC. Classifying IBTR may provide clinical significance for treatments.
目的
保乳治疗（BCT）后的第二原发乳腺癌包括同侧乳房肿瘤复发（IBTR）和异时性对侧乳腺癌（CBC）。每一次 IBTR 进一步分为真性复发（TR）或新原发性肿瘤（NP）。我们旨在比较 TR、NP 和 CBC 的生存结果，并探讨最佳治疗方法。
方法
在 SEER 数据库中，我们确定了 1990 年至 2005 年间接受 BCT 的 168427 例原发性乳腺癌患者。通过年危险率估计 IBTR 和 CBC 的风险。使用多变量 Cox 回归分析评估乳腺癌特异性生存（BCSS）。
结果
在 BCT 后中位随访 13 年后，5413 例患者发生 IBTR，4050 例患者发生 CBC。IBTR 的风险在 BCT 后 10 至 15 年达到高峰，而 CBC 的风险分布均匀。IBTR 中有 45.9%被归类为 TR，54.1%为 NP。从原发性乳腺癌到 NP 的时间间隔长于到 TR 和 CBC（P<0.001）。与 NP（P=0.003）和 CBC（P=0.002）相比，TR 患者的 BCSS 更差。TR 或 NP 治疗中，乳房切除术与重复 BCT 之间的 BCSS 无差异（P=0.584）或 NP（P=0.243）。CBC 行 BCT 治疗的 BCSS 优于乳房切除术（P=0.010）。化疗并没有改善 TR 患者的生存（P=0.058）。然而，III 级或阴性激素受体的 TR 从化疗中显著获益。
结论
与 NP 和 CBC 相比，TR 患者的 BCSS 更差。IBTR 的分类可能为治疗提供临床意义。
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