Gage I, Schnitt S J, Recht A, Abner A, Come S, Shulman L N, Monson J M, Silver B, Harris J R, Connolly J L
Joint Center for Radiation Therapy, Boston, MA, USA.
J Clin Oncol. 1998 Feb;16(2):480-6. doi: 10.1200/JCO.1998.16.2.480.
To assess the frequency and prognosis of skin recurrences after breast-conserving therapy (BCT) compared with other breast recurrences.
From 1968 to 1986, 1,624 patients with unilateral stage I or II breast cancer treated with BCT at the Joint Center for Radiation Therapy (Boston, MA) underwent gross tumor excision and received a dose of > or = 60 Gy to the tumor bed. Skin recurrences (SR) were defined as breast recurrences without associated parenchymal disease. An invasive breast recurrence with any parenchymal disease noted clinically or radiographically was scored as an other breast recurrence (OBR). Median follow-up for survivors was 137 months.
SR represented 8% (18 of 229) of all breast recurrences and occurred in 1.1% of all patients. The outcome after local recurrence was different for patients with SR and invasive OBR. Patients with SR more frequently had uncontrolled local failure (50%; 9 of 18) than did patients with OBR (14%; 26 of 188) (P = .0007). Forty-four percent (8 of 18) of patients with SR had distant metastasis simultaneously or within 2 months of the recurrence compared with 5% (9 of 188) of invasive OBR patients (P < .0001). For patients without distant metastasis at the time of recurrence, the 5-year actuarial rate of development of distant metastasis was 60% for SR patients compared with 39% for invasive OBR patients (P = .07), and the corresponding 5-year actuarial survival rates beyond the time of local failure were 51% and 79%, respectively (P = .06).
In contrast to other types of invasive breast recurrence after breast-conserving therapy, skin recurrences are rare and are associated with a significantly higher rate of distant metastasis and uncontrolled local disease as well as a lower rate of survival.
评估保乳治疗（BCT）后皮肤复发与其他乳腺复发相比的频率及预后。
1968年至1986年期间，在联合放射治疗中心（马萨诸塞州波士顿）接受BCT治疗的1624例单侧I期或II期乳腺癌患者接受了肿瘤大体切除，并接受了≥60 Gy的瘤床剂量照射。皮肤复发（SR）定义为无相关实质疾病的乳腺复发。临床上或影像学上发现有任何实质疾病的浸润性乳腺复发被记为其他乳腺复发（OBR）。幸存者的中位随访时间为137个月。
SR占所有乳腺复发的8%（229例中的18例），发生在所有患者的1.1%中。SR患者和浸润性OBR患者局部复发后的结局不同。SR患者局部未控失败的频率（50%；18例中的9例）高于OBR患者（14%；188例中的26例）（P = .0007）。44%（18例中的8例）的SR患者在复发时或复发后2个月内同时出现远处转移，而浸润性OBR患者为5%（188例中的9例）（P < .0001）。对于复发时无远处转移的患者，SR患者远处转移发生的5年精算率为60%，而浸润性OBR患者为39%（P = .07），局部失败后相应的5年精算生存率分别为51%和79%（P = .06）。
与保乳治疗后其他类型的浸润性乳腺复发相比，皮肤复发罕见，且与远处转移率显著更高、局部疾病未控以及生存率更低相关。
