Torras Ines, Cebrecos Isaac, Castillo Helena, Rodríguez Laura, Zaragoza-Ballester Pablo, Sitges Carla, Loinaz Ignacio, Garcia Marta, Molla Meritxell, Vidal-Sicart Sergi, Mension Eduard
Department of Obstetrics and Gynecology and Neonatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain.
Faculty of Medicine, University of Barcelona, 08007 Barcelona, Spain.
J Clin Med. 2024 Aug 29;13(17):5142. doi: 10.3390/jcm13175142.
Breast cancer (BC) recurrence, defined as the reappearance of cancer in the ipsilateral breast after primary treatment, poses significant challenges in clinical management. Despite advances in treatment, recurrence rates persist, ranging from 0.6 to 1.5% annually, reaching 10-15% at 20 years. This study aims to analyze the surgical and oncological characteristics of patients with BC recurrence. This retrospective study includes 56 patients diagnosed with recurrent BC between October 2018 and April 2022. Data were collected from a prospectively maintained surgical database. A descriptive analysis was performed on the initial BC, and the recurrence, including surgical complications, was classified using the Clavien-Dindo system. The success rates of selective sentinel lymph node (SLN) biopsies and aberrant drainages were assessed based on previous surgeries. : The cohort included 55 females and 1 male, with a median age of 65.3 years. The mean time to BC recurrence was 11.5 years. Among them, 26.8% underwent breast-conserving surgery, 41.1% had a mastectomy, 21.4% had a mastectomy with reconstruction, and 10.7% had an excision over a previous mastectomy. An SLN biopsy was performed in 78.6% of cases, with higher success rates in those without a previous axillary lymph node dissection (85.7% vs. 63.2%). Aberrant drainage was more frequent in patients with a previous ALND (44.4% vs. 20%). The median follow-up was 41.3 months, with 10.7% experiencing a second recurrence. Repeat breast-conserving surgery with re-irradiation for ipsilateral recurrence is feasible and does not significantly increase complications. SLN biopsy is valuable for restaging and tailoring adjuvant therapies, with ALND not being necessary if re-SLN biopsy shows no drainage. The management of aberrant drainage remains controversial.
乳腺癌（BC）复发是指在初次治疗后同侧乳房再次出现癌症，这给临床管理带来了重大挑战。尽管治疗取得了进展，但复发率仍然存在，每年为0.6%至1.5%，20年时达到10% - 15%。本研究旨在分析BC复发患者的手术和肿瘤学特征。这项回顾性研究纳入了2018年10月至2022年4月期间诊断为复发性BC的56例患者。数据来自前瞻性维护的手术数据库。对初始BC进行描述性分析，并使用Clavien-Dindo系统对复发情况（包括手术并发症）进行分类。根据既往手术情况评估选择性前哨淋巴结（SLN）活检和异常引流的成功率。该队列包括55名女性和1名男性，中位年龄为65.3岁。BC复发的平均时间为11.5年。其中，26.8%接受了保乳手术，41.1%进行了乳房切除术，21.4%进行了乳房切除并重建，10.7%在既往乳房切除术后进行了切除手术。78.6%的病例进行了SLN活检，既往未进行腋窝淋巴结清扫的患者成功率更高（85.7%对63.2%）。既往进行腋窝淋巴结清扫的患者异常引流更常见（44.4%对20%）。中位随访时间为41.3个月，10.7%的患者出现二次复发。对于同侧复发，再次保乳手术并重新放疗是可行的，且不会显著增加并发症。SLN活检对于重新分期和调整辅助治疗很有价值，如果再次SLN活检未显示引流，则无需进行腋窝淋巴结清扫。异常引流的处理仍存在争议。
