Haffty B G, Carter D, Flynn S D, Fischer D B, Brash D E, Simons J, Ziegler A M, Fischer J J
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06510.
Int J Radiat Oncol Biol Phys. 1993 Oct 20;27(3):575-83. doi: 10.1016/0360-3016(93)90382-6.
The purpose of this study was to perform a detailed clinical pathological analysis of breast relapses in patients treated with conservative surgery and radiation therapy in an effort to classify those relapses as true local recurrences or second primary tumors, and to assess the prognostic and therapeutic implications of such a classification system.
Of 990 patients treated with conservative surgery and radiation therapy at our facilities prior to December 1987, 82 patients have experienced a relapse in the conservatively treated breast as the primary site of failure. Patients were classified as having new primary tumors if they fulfilled any one of the following criteria: a) breast relapse occurring at a site distinctly removed from the original tumor; b) histology of the breast relapse compared with the original tumor consistent with a new primary; or c) DNA flow cytometry converting from an aneuploid primary to a diploid relapse.
As of 2/92, with a median follow-up of 5.4 years from the time of breast relapse, the overall 5-year survival rate following breast relapse was 55%. Forty-seven patients were classified as true recurrences and 33 patients were classified as new primaries. Patients classified as true recurrences had a shorter median time to breast relapse than patients classified as new primaries (3.16 years vs. 5.42 years, p < .05) and an inferior post breast recurrence survival rate compared to patients classified as new primaries (36% vs. 89%, p < .05). Residual disease outside of the recurrent tumor bed was also noted to be more frequent in patients classified as true recurrences compared to patients classified as new primaries (48% vs. 16%, p < .05).
Based on the clinical and pathological criteria outlined, it appears that a significant portion of patients experiencing a relapse in the conservatively treated breast may have new primary tumors as opposed to true local relapses. Distinction between a true recurrence and a new primary tumor may have significant prognostic implications. Uncertainties associated with the clinical and pathological criteria are presented and further investigations with genetic fingerprinting techniques to establish the clonality of breast relapses are presented and discussed.
本研究旨在对接受保乳手术和放射治疗的患者的乳腺复发进行详细的临床病理分析，以便将这些复发分类为真正的局部复发或第二原发性肿瘤，并评估这种分类系统对预后和治疗的影响。
在1987年12月之前于我们机构接受保乳手术和放射治疗的990例患者中，有82例患者在接受保乳治疗的乳腺中出现复发，将其作为主要失败部位。如果患者符合以下任何一项标准，则被分类为患有新的原发性肿瘤：a）乳腺复发发生在与原发肿瘤明显不同的部位；b）乳腺复发的组织学与原发肿瘤相比符合新的原发性肿瘤；或c）DNA流式细胞术从非整倍体原发性肿瘤转变为二倍体复发。
截至1992年2月，自乳腺复发时起的中位随访时间为5.4年，乳腺复发后的总体5年生存率为55%。47例患者被分类为真正的复发，33例患者被分类为新的原发性肿瘤。被分类为真正复发的患者乳腺复发的中位时间比被分类为新原发性肿瘤的患者短（3.16年对5.42年，p <.05），与被分类为新原发性肿瘤的患者相比，乳腺复发后的生存率较低（36%对89%，p <.05）。与被分类为新原发性肿瘤的患者相比，被分类为真正复发的患者在复发肿瘤床外的残留疾病也更常见（48%对16%，p <.05）。
根据所述的临床和病理标准，似乎在接受保乳治疗的乳腺中出现复发的患者中，很大一部分可能患有新原发性肿瘤而非真正的局部复发。真正复发与新原发性肿瘤之间的区分可能对预后有重大影响。本文介绍了与临床和病理标准相关的不确定性，并提出并讨论了使用基因指纹技术进一步研究以确定乳腺复发的克隆性。
