皮肤累及对乳腺癌患者胸壁复发的预后意义。

The prognostic significance of skin involvement in breast cancer patients with chest wall recurrence.

机构信息

Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.

State Key Laboratory of Oncology in South China, Guangzhou, China.

出版信息

Ann Med. 2023 Dec;55(1):2232299. doi: 10.1080/07853890.2023.2232299.

DOI:10.1080/07853890.2023.2232299

PMID:37431586

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10337506/

Abstract

PURPOSE

To assess the prognostic significance of skin involvement in breast cancer patients with chest wall recurrence (CWR).

METHODS

We retrospectively analyzed the clinicopathological data of breast cancer patients with CWR who were diagnosed pathologically between January 2000 and April 2020. Disease-free survival (DFS) was the time from radical resection for CWR to disease recurrence. Progression-free survival (PFS) was defined as the time from the diagnosis of locally unresectable CWR to the first sign of disease progression. Persistent chest wall progression was defined as three consecutive chest wall progressions with no distant organ involvement.

RESULTS

A total of 476 patients with CWR were included in this study. Skin involvement was confirmed in 345 patients. Skin involvement was significantly correlated with a high T stage ( = 0.003), more positive nodes at initial examination ( < 0.001) and lymphovascular invasion ( < 0.001). Kaplan-Meier analysis showed that skin involvement was a predictor of shorter DFS ( < 0.001), including both local disease progression ( < 0.001) and distant disease progression ( = 0.022). Multivariate analysis showed that skin involvement was an independent biomarker for DFS ( = 0.043). Patients with skin involvement were more likely to experience persistent chest wall progression ( = 0.040). After eliminating the potential deviation caused by an insufficient follow-up time, persistent chest wall progression was more likely to be associated with a high N stage ( = 0.002), negative progesterone receptor (PR; = 0.001) and positive human epidermal growth factor receptor 2 (HER2; = 0.046) of the primary site, and negative oestrogen receptor (ER; = 0.027) and PR ( = 0.013) of the chest wall lesion and skin involvement ( = 0.020).

CONCLUSION

Skin involvement was a predictor of poor disease control in patients with CWR and was closely related to persistent chest wall progression. We stratified the prognosis of individualized treatment for breast cancer patients with CWR to provide new insights into the biological behaviours of the disease.

摘要

目的

评估乳腺癌患者胸壁复发（CWR）伴皮肤受累的预后意义。

方法

我们回顾性分析了 2000 年 1 月至 2020 年 4 月期间经病理诊断为 CWR 的乳腺癌患者的临床病理资料。无病生存期（DFS）是从 CWR 的根治性切除到疾病复发的时间。无进展生存期（PFS）定义为局部不可切除的 CWR 首次诊断至疾病进展的第一个迹象。持续性胸壁进展定义为连续三次胸壁进展而无远处器官受累。

结果

本研究共纳入 476 例 CWR 患者，其中 345 例证实有皮肤受累。皮肤受累与 T 分期较高（ = 0.003）、初始检查阳性淋巴结更多（ < 0.001）和脉管侵犯（ < 0.001）显著相关。Kaplan-Meier 分析显示，皮肤受累是 DFS 较短的预测因素（ < 0.001），包括局部疾病进展（ < 0.001）和远处疾病进展（ = 0.022）。多变量分析显示，皮肤受累是 DFS 的独立生物标志物（ = 0.043）。有皮肤受累的患者更有可能出现持续性胸壁进展（ = 0.040）。在消除随访时间不足导致的潜在偏差后，持续性胸壁进展更可能与较高的 N 分期（ = 0.002）、原发性部位孕激素受体（PR； = 0.001）和人表皮生长因子受体 2（HER2； = 0.046）阴性、胸壁病变和皮肤受累的雌激素受体（ER； = 0.027）和 PR（ = 0.013）阴性相关。