Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
Breast Cancer Res Treat. 2022 Nov;196(1):97-109. doi: 10.1007/s10549-022-06708-y. Epub 2022 Aug 30.
Salvage mastectomy is traditionally recommended for patients who developed ipsilateral breast tumor recurrence (IBTR) in light of previous breast irradiation. However, it remains controversial whether surgical axillary staging (SAS) is necessary for IBTR patients with negative nodes. This study aimed to evaluate the oncologic safety of omitting SAS for IBTR.
We retrospectively identified patients who developed invasive IBTR with negative nodes after undergoing breast-conserving surgery (BCS) from 2010 to 2018. Patterns of care in nodal staging were analyzed based on prior axillary staging status. Clinicopathologic characteristics and adjuvant treatment of the initial tumor, as well as the IBTR, were compared between the SAS and no SAS groups. Kaplan-Meier method and Cox regression model were utilized to compare the locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates after IBTR removal between the two groups.
A total of 154 IBTR patients were eligible for final analysis. Compared to the no SAS group, SAS group was less likely to undergo ALND (15.1 vs 73.3%, p < 0.001) at initial BCS, had a longer recurrence interval (2.8 vs 2.1 years, p = 0.03), and were more likely to have discordant molecular subtype (35.8 vs 12.9%, p = 0.001) and different quadrant location (37.7 vs 19.8%, p = 0.02) with primary tumor. However, the extent of axillary staging did not affect systemic or radiation recommendations. In the subgroup of patients without previous ALND, the clinicopathologic characteristics were roughly comparable. No significant differences were observed in LRRFS, DMFS or OS between the two groups.
For node-negative IBTR patients, we observed selection bias on the basis of prior ALND, shorter recurrence interval, and concordant molecular subtype favoring no SAS but comparable LRRFS, DMFS, and OS. These results support a wider consideration of sparing SAS in the management of IBTR, especially in patients without previous ALND.
对于先前接受过乳房放疗后同侧乳房肿瘤复发（IBTR）的患者，传统上建议进行挽救性乳房切除术。然而，对于淋巴结阴性的 IBTR 患者是否需要进行外科腋窝分期（SAS）仍存在争议。本研究旨在评估省略 SAS 对 IBTR 的肿瘤安全性。
我们回顾性地确定了 2010 年至 2018 年间接受保乳手术后出现淋巴结阴性浸润性 IBTR 的患者。根据先前的腋窝分期状态分析了淋巴结分期的护理模式。比较了 SAS 组和无 SAS 组的初始肿瘤的临床病理特征和辅助治疗，以及 IBTR 的情况。采用 Kaplan-Meier 方法和 Cox 回归模型比较两组 IBTR 切除后的局部区域无复发生存率（LRRFS）、无远处转移生存率（DMFS）和总生存率（OS）。
共有 154 例 IBTR 患者符合最终分析标准。与无 SAS 组相比，SAS 组在初始保乳手术时更不可能进行腋窝清扫术（15.1%对 73.3%，p<0.001），复发间隔更长（2.8 年对 2.1 年，p=0.03），且更有可能具有不同的分子亚型（35.8%对 12.9%，p=0.001）和原发肿瘤不同的象限位置（37.7%对 19.8%，p=0.02）。然而，腋窝分期的范围并没有影响全身治疗或放疗建议。在没有先前接受过 ALND 的患者亚组中，临床病理特征大致相似。两组间 LRRFS、DMFS 或 OS 无显著差异。
对于淋巴结阴性的 IBTR 患者，我们观察到基于先前的 ALND、较短的复发间隔和一致的分子亚型的选择偏倚有利于不进行 SAS，但 LRRFS、DMFS 和 OS 无显著差异。这些结果支持在 IBTR 的管理中更广泛地考虑省略 SAS，特别是在没有先前接受过 ALND 的患者中。
