Zhu Anjie, Yun Zehui, You Miaoning, Liu Xiaoran, Liang Xu, Yan Ying, Shao Bin, Jiang Hanfang, Di Lijun, Song Guohong, Li Huiping
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China.
Gland Surg. 2022 Jun;11(6):1015-1025. doi: 10.21037/gs-22-246.
Patients with breast cancer (BC) may develop locoregional recurrence alone or with distant metastases. Results of previous studies discussing the benefit of local surgery among patients with chest wall disease were controversial. Whether surgical reduction for chest wall disease could influence survival outcome is still a question. The objective of this study was to compare overall survival (OS) in patients with recurrence involving the chest wall who did or did not undergo surgical reduction after previous treatment of the primary BC to explore the role of surgical reduction.
We retrospectively reviewed BC patients with chest wall as the first recurrent/metastatic site selected between January 2012 and December 2018 to explore whether surgical reduction for chest wall disease could influence OS. Clinicopathological data, including age at initial diagnosis, TNM stage, the pathological parameters, and treatment were recorded and analyzed. OS was primarily described using the Kaplan-Meier estimator for each group, with the statistical significance between groups being tested by the log-rank test.
A total of 198 patients with a median age of 48 years (range, 22-73 years) were analyzed. Chest wall as the only site of recurrence occurred in 139 patients (70.2%), and the other 59 (29.8%) patients had other metastatic sites. There were 88 patients who underwent surgical reduction for chest wall recurrence. The median OS was significantly longer for the patients who had chest wall disease reduction than for those who did not {194.2 months [95% confidence interval (CI): 140.4-247.9 months] 102.7 months (95% CI: 79.7-125.7 months), respectively, P=0.001}. From multivariate analysis, surgical reduction was an independent factor significantly influenced OS (HR =0.52, 95% CI: 0.33-0.81, P=0.004). Subgroup analyses showed that OS was statistically longer in the chest wall disease surgical reduction group than in the no reduction group with respect to hormone receptor (HR) negative (-), human epidermal growth factor receptor 2 (HER2) negative (-), triple-negative breast cancer (TNBC), disease-free survival (DFS) >24 months, and chest wall disease only.
BC patients with chest wall recurrence could benefit from surgical reduction with a prolonged OS. In a certain selected group, surgical reduction may be warranted.
乳腺癌（BC）患者可能单独出现局部区域复发或伴有远处转移。先前关于胸壁疾病患者行局部手术益处的研究结果存在争议。胸壁疾病的手术减瘤是否会影响生存结局仍是一个问题。本研究的目的是比较在原发性乳腺癌先前治疗后胸壁复发的患者中，接受或未接受手术减瘤患者的总生存期（OS），以探讨手术减瘤的作用。
我们回顾性分析了2012年1月至2018年12月间以胸壁作为首个复发/转移部位的BC患者，以探讨胸壁疾病的手术减瘤是否会影响总生存期。记录并分析临床病理数据，包括初始诊断年龄、TNM分期、病理参数和治疗情况。主要使用Kaplan-Meier估计量描述每组的总生存期，组间差异采用对数秩检验进行统计学检验。
共分析了198例患者（中位年龄48岁，范围22 - 73岁）。139例患者（70.2%）胸壁是唯一的复发部位，另外59例（29.8%）患者有其他转移部位。88例患者因胸壁复发接受了手术减瘤。胸壁疾病减瘤患者的中位总生存期显著长于未减瘤患者{分别为194.2个月[95%置信区间（CI）：140.4 - 247.9个月]和102.7个月（95% CI：79.7 - 125.7个月），P = 0.001}。多因素分析显示，手术减瘤是显著影响总生存期的独立因素（HR = 0.52，95% CI：0.33 - 0.81，P = 0.004）。亚组分析表明，在激素受体（HR）阴性（-）、人表皮生长因子受体2（HER2）阴性（-）、三阴性乳腺癌（TNBC）、无病生存期（DFS）>24个月以及仅胸壁疾病的患者中，胸壁疾病手术减瘤组的总生存期在统计学上长于未减瘤组。
胸壁复发的BC患者可从手术减瘤中获益，总生存期延长。在某些特定选择的患者组中，可能有必要进行手术减瘤。
