Tafra L, Essner R, Brenner R J, Giuliano A E
Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute, Saint John's Hospital and Health Center, Santa Monica, California 90404, USA.
Am Surg. 1996 May;62(5):395-9.
Most mammographically detected breast cancers are small, nonpalpable malignancies that should be amenable to cure by definitive breast-conserving therapy (BCT) consisting of tumor excision and postoperative radiation. We examined this hypothesis by retrospectively comparing the incidence of local recurrence and the rate of survival in breast cancer patients undergoing BCT for nonpalpable versus palpable lesions. Between 1982 and 1991, 345 patients at the John Wayne Cancer Institute, a large referral center for breast diseases, underwent BCT for invasive ductal and/or invasive lobular breast carcinomas: 120 (35%) had nonpalpable lesions detected by mammography (MG group), and 225 (65%) had palpable lesions detected by physical exam (PE group). The clinical and pathologic tumor status and the clinical outcome were recorded in each case. Median tumor size was significantly larger in PE than MG patients (2 cm versus 1 cm, P < 0.001). Only 29 percent of MG patients were premenopausal, compared with 51 percent of PE patients (P < 0.05). Axillary node involvement was more frequent in PE than MG patients (46% versus 19%, P < 0.01). Over a median follow-up of 58 months, local recurrence rates were 8 per cent for both MG and PE patients. In both groups, the incidence of local recurrence increased significantly when tumor was found in the margins of the resected breast specimen. In the MG group, the risk of local recurrence was significantly higher in premenopausal patients (P < 0.05). Survival was similar in both groups. The rate of local recurrence after BCT is the same for nonpalpable and palpable breast tumors. However, nonpalpable lesions have a lower rate of regional node metastases, which may improve survival. Both local recurrence and metastases seem to be related to tumor size. Tumor-free operative margins are the best predictor of local control.
大多数通过乳腺钼靶检查发现的乳腺癌是微小的、触诊不到的恶性肿瘤，应该可以通过包括肿瘤切除和术后放疗的确定性保乳治疗（BCT）治愈。我们通过回顾性比较接受BCT治疗触诊不到与触诊可及病变的乳腺癌患者的局部复发率和生存率，来检验这一假设。1982年至1991年期间，约翰·韦恩癌症研究所（一家大型乳腺疾病转诊中心）的345例患者因浸润性导管癌和/或浸润性小叶癌接受了BCT：120例（35%）通过乳腺钼靶检查发现触诊不到的病变（MG组），225例（65%）通过体格检查发现触诊可及的病变（PE组）。记录每例患者的临床和病理肿瘤状态以及临床结局。PE组患者的肿瘤中位大小显著大于MG组患者（2厘米对1厘米，P<0.001）。MG组仅29%的患者为绝经前患者，而PE组为51%（P<0.05）。PE组腋窝淋巴结受累比MG组患者更常见（46%对19%，P<0.01）。中位随访58个月时，MG组和PE组患者的局部复发率均为8%。在两组中，当在切除的乳腺标本边缘发现肿瘤时，局部复发率显著增加。在MG组中，绝经前患者局部复发风险显著更高（P<0.05）。两组生存率相似。BCT后触诊不到和触诊可及的乳腺肿瘤局部复发率相同。然而，触诊不到的病变区域淋巴结转移率较低，这可能会提高生存率。局部复发和转移似乎都与肿瘤大小有关。切缘无肿瘤是局部控制的最佳预测指标。
