Harrold E V, Turner B C, Matloff E T, Pathare P, Beinfield M, McKhann C, Ward B A, Haffty B G
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520-8040, USA.
Cancer J Sci Am. 1998 Sep-Oct;4(5):302-7.
The purpose of this study was to evaluate the relationships among young age at diagnosis, family history status, and local recurrence in breast cancer patients treated with lumpectomy and radiation therapy.
Between January 1970 and December 1990, 984 early-stage breast cancer patients were treated with conservative surgery and radiation therapy at Yale-New Haven Hospital. All patient data, including demographics, staging information, treatment, and outcome variables were entered into a computerized database. The current study focused on the relationships between young age, family history, and local relapse. A group of 52 patients who experienced a local recurrence in the conservatively treated breast and 52 matched control patients who had not experienced a local recurrence were asked to participate in a study to determine whether local recurrence was associated with family history. Detailed family history interviews were conducted, and pedigrees were analyzed by a genetic counselor who was blind to the clinical history of the patients.
As of September 1997, with a median follow-up of 12.3 years for the 984 patients in the database, the overall actuarial 10-year survival is 73%, and the 10-year distant metastasis-free survival is 78%. Of the 984 patients, 112 have experienced a local relapse in the conservatively treated breast, resulting in a 10-year actuarial breast relapse rate of 15%. The 10-year survival after breast relapse is 69%. Patient age tested as a continuous variable correlated strongly with ipsilateral breast tumor relapse. Using age 40 as a cutpoint, patients aged 40 years or less had a significantly higher local relapse rate than patients older than 40 years (P < 0.001). Although the relationship between local relapse and young age was strong, no association was found between family history and local relapse in the detailed family history study.
Young age at diagnosis was a significant prognostic factor for local relapse. In a detailed family history study using a case-control design, no significant differences in family history status were found between patients who had experienced a local relapse and patients who had not.
本研究的目的是评估接受保乳手术和放射治疗的乳腺癌患者诊断时年龄较轻、家族史状况与局部复发之间的关系。
1970年1月至1990年12月期间，984例早期乳腺癌患者在耶鲁-纽黑文医院接受了保守手术和放射治疗。所有患者数据，包括人口统计学、分期信息、治疗和结局变量，都录入了计算机数据库。当前研究聚焦于年轻、家族史与局部复发之间的关系。一组52例在接受保守治疗的乳房中出现局部复发的患者和52例未出现局部复发的匹配对照患者被要求参与一项研究，以确定局部复发是否与家族史有关。进行了详细的家族史访谈，由一位对患者临床病史不知情的遗传咨询师分析家系图。
截至1997年9月，数据库中984例患者的中位随访时间为12.3年，总体精算10年生存率为73%，10年无远处转移生存率为78%。984例患者中，112例在接受保守治疗的乳房中出现了局部复发，导致10年精算乳房复发率为15%。乳房复发后的10年生存率为69%。作为连续变量测试的患者年龄与同侧乳房肿瘤复发密切相关。以40岁为切点，40岁及以下的患者局部复发率显著高于40岁以上的患者（P < 0.001）。尽管局部复发与年轻之间的关系密切，但在详细的家族史研究中，未发现家族史与局部复发之间存在关联。
诊断时年龄较轻是局部复发的一个重要预后因素。在一项采用病例对照设计的详细家族史研究中，出现局部复发的患者与未出现局部复发的患者在家族史状况方面未发现显著差异。
