Chest wall recurrence after mastectomy does not always portend a dismal outcome
Chest wall recurrence after mastectomy does not always portend a dismal outcome
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DOI：
10.1245/aso.2003.01.004
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发表时间：
2003-07-01
影响因子：
3.7
通讯作者：
Kuerer, HM
中科院分区：
文献类型：
--
作者：
Chagpar, A;Meric-Bernstam, F;Kuerer, HM
背景：乳房切除术后的胸壁复发（CWR）通常预示着严峻的预后。然而，CWR 后结果的预测因素尚不清楚。方法：从 1988 年到 1998 年，我们中心收治了 130 名孤立性 CWR 患者。通过单变量和多变量分析来研究 CWR 后无远处转移生存的临床病理因素。 CWR 后随访中位数为 37 个月。结果：单变量分析显示，初始淋巴结状态是结果的最强预测因子。其他重要因素包括初始 T4 疾病、原发性淋巴血管侵犯、用新辅助治疗或放射治疗原发肿瘤、CWR 时间>24 个月以及 CWR 治疗（手术、放射或多学科治疗）。多变量分析还发现初始淋巴结状态的影响最大。 CWR 时间和 CWR 辐射的使用也是独立的预测因素。确定了三组患者。低风险的定义是初始淋巴结阴性疾病、CWR 时间>24 个月以及 CWR 辐射；中等风险具有一两个有利特征；而高风险则没有。 CWR 后的中位无远处转移生存期在这些组中显着不同 (P < .0001)。结论：CWR 患者是一个异质人群。最初淋巴结阴性的患者在 24 个月后出现 CWR，预后乐观，尤其是在接受放射治疗的情况下。
Background: Chest wall recurrence (CWR) after mastectomy often forecasts a grim prognosis. Predictors of outcome after CWR, however, are not clear.Methods: From 1988 to 1998, 130 patients with isolated CWRs were seen at our center. Clinicopathologic factors were studied by univariate and multivariate analyses for distant metastasis-free survival after CWR. The median post-CWR follow-up was 37 months.Results: Initial nodal status was the strongest predictor of outcome by univariate analysis. Other significant factors included initial T4 disease, primary lymphovascular invasion, treatment of the primary tumor with neoadjuvant therapy or radiation, time to CWR >24 months, and treatment for CWR (surgery, radiation, or multimodality therapy). Multivariate analysis also found initial nodal status to have the greatest effect; time to CWR and use of radiation for CWR were also independent predictors. Three groups of patients were identified. Low risk was defined by initial node-negative disease, time to CWR >24 months, and radiation for CWR; intermediate risk had one or two favorable features; and high risk had none. The median distant metastasis-free survival after CWR was significantly different among these groups (P < .0001).Conclusions: Patients with CWR are a heterogeneous population. Patients with initial node-negative disease who develop CWR after 24 months have an optimistic prognosis, especially if they are treated with radiation.