Faneyte I F, Rutgers E J, Zoetmulder F A
Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek ziekenhuis, Amsterdam.
Cancer. 1997 Sep 1;80(5):886-91.
Locoregional recurrence after initial treatment of breast carcinoma occurs in up to 35% of patients. In selected patients, chest wall resection (CWR) can be performed to regain local control. Extensive surgery is justifiable only if good palliation and possibly a better prognosis can be offered and the morbidity is limited.
The authors conducted a retrospective review of the medical records of 44 females with locally recurrent breast carcinoma who underwent chest wall resection between 1979 and 1995 at the Netherlands Cancer Institute. Preoperative patient characteristics were recorded, and complications were scored. Analysis was made of disease free and overall survival after resection as well as the influence of presumed prognostic factors on survival. The median duration of follow-up was 3.2 years.
The mean patient age at diagnosis of breast carcinoma was 47.5 years. The median interval between first treatment and relapse was 3.9 years. Thirty patients (68%) underwent CWR with curative intent. Postoperative complications occurred in 18 patients, but no mortality occurred. The median disease free interval after curative CWR was 3.3 years; the projected 5-year disease free survival rate was 35%. A disease free interval of more than 2 years after primary treatment predisposed patients to significantly longer tumor free survival after CWR, compared with an interval shorter than 2 years (P = 0.0001). New local recurrence after curative CWR occurred in 6 patients (20%), and distant metastases occurred in 17. Median overall survival was 4.8 years; the projected 5-year survival rate was 45%. After curative resection, these figures were 8.9 years and 58%, respectively, whereas palliative resection resulted in a median survival of 2.3 years and a projected 5-year survival of 21% (P = 0.008). Age > or =35 years at the time of the first diagnosis of breast carcinoma predisposed patients to significantly better survival than age <35 years (P = 0.02).
CWR can provide local control, good palliation, and an acceptable prognosis for patients with recurrence of breast carcinoma. Outcome mainly depends on the completeness of the resection.
乳腺癌初始治疗后局部区域复发率高达35%。对于部分患者，可行胸壁切除术（CWR）以重新获得局部控制。仅当能提供良好的姑息治疗且可能有更好的预后，且并发症有限时，广泛手术才是合理的。
作者对1979年至1995年在荷兰癌症研究所接受胸壁切除术的44例局部复发性乳腺癌女性患者的病历进行了回顾性研究。记录术前患者特征，并对并发症进行评分。分析了切除术后的无病生存期和总生存期以及假定的预后因素对生存的影响。中位随访时间为3.2年。
乳腺癌诊断时患者的平均年龄为47.5岁。首次治疗与复发之间的中位间隔时间为3.9年。30例（68%）患者行CWR目的是治愈。18例患者发生术后并发症，但无死亡病例。根治性CWR后的中位无病间隔时间为3.3年；预计5年无病生存率为35%。与间隔时间短于2年相比，初次治疗后无病间隔时间超过2年的患者在CWR后无瘤生存期明显更长（P = 0.0001）。根治性CWR后6例（20%）患者出现新的局部复发，17例出现远处转移。中位总生存期为4.8年；预计5年生存率为45%。根治性切除后，这些数字分别为8.9年和58%，而姑息性切除的中位生存期为2.3年，预计5年生存率为21%（P = 0.008）。首次诊断乳腺癌时年龄≥35岁的患者比年龄＜35岁的患者生存率明显更好（P = 0.02）。
CWR可为乳腺癌复发患者提供局部控制、良好的姑息治疗和可接受的预后。结果主要取决于切除的完整性。
