Abner A L, Recht A, Eberlein T, Come S, Shulman L, Hayes D, Connolly J L, Schnitt S J, Silver B, Harris J R
Department of Radiation Oncology, Beth Isreal Hospital, Boston, MA.
J Clin Oncol. 1993 Jan;11(1):44-8. doi: 10.1200/JCO.1993.11.1.44.
The prognosis and factors that influence prognosis following salvage mastectomy in patients with recurrence in the treated breast after conservative surgery (CS) and radiation therapy (RT) were investigated.
A total of 1,593 patients with stage I or II invasive breast cancer were treated following gross total excision of the tumor at the Joint Center for Radiation Therapy (JCRT) between 1968 and 1985. One hundred sixty-six of the 1,593 (10%) had subsequent recurrence in the breast. Of these, 123 had salvage mastectomy and constitute the study population. The recurrent tumor was predominantly invasive in 99 patients, noninvasive in 14, and focally invasive in 10. Following mastectomy, chemotherapy or hormonal therapy was administered to 29 patients. The median follow-up time was 39 months after salvage mastectomy.
The 5-year actuarial rate of further local or distant relapse for the entire group was 41%. None of the 24 patients with focally invasive or noninvasive tumors had a subsequent relapse. In comparison, the 5-year actuarial rate of further relapse in the 99 patients with a predominantly invasive recurrence was 52% (P = .001). The method of detection of the recurrence, the age of the patient at initial diagnosis, the disease-free interval, and the location of the recurrence in the breast were not found to have a statistically significant association with the risk of further relapse.
We conclude that the histology of the recurrent tumor is an important prognostic factor for the risk of further relapse. Patients with purely noninvasive or focally invasive tumors have an excellent prognosis following salvage mastectomy. In contrast, patients with predominantly invasive tumors are at substantial risk for further relapse.
研究保乳手术（CS）和放射治疗（RT）后患侧乳房复发的患者行挽救性乳房切除术后的预后及影响预后的因素。
1968年至1985年间，共有1593例I期或II期浸润性乳腺癌患者在放射治疗联合中心（JCRT）接受了肿瘤全切术。1593例患者中有166例（10%）随后出现患侧乳房复发。其中，123例行挽救性乳房切除术，构成研究人群。复发性肿瘤主要为浸润性的有99例，非浸润性的有14例，局灶性浸润性的有10例。乳房切除术后，29例患者接受了化疗或激素治疗。挽救性乳房切除术后的中位随访时间为39个月。
整个研究组5年局部或远处进一步复发的精算率为41%。24例局灶性浸润性或非浸润性肿瘤患者均未出现后续复发。相比之下，99例主要为浸润性复发患者的5年进一步复发精算率为52%（P = 0.001）。未发现复发的检测方法、初次诊断时患者的年龄、无病间期以及乳房复发部位与进一步复发风险存在统计学显著关联。
我们得出结论，复发性肿瘤的组织学类型是进一步复发风险的重要预后因素。单纯非浸润性或局灶性浸润性肿瘤患者行挽救性乳房切除术后预后良好。相比之下，主要为浸润性肿瘤的患者有较高的进一步复发风险。
