SURVIVAL FOLLOWING LOCOREGIONAL RECURRENCE OF BREAST-CANCER - UNIVARIATE AND MULTIVARIATE-ANALYSIS
SURVIVAL FOLLOWING LOCOREGIONAL RECURRENCE OF BREAST-CANCER - UNIVARIATE AND MULTIVARIATE-ANALYSIS
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DOI：
10.1016/0360-3016(92)90743-2
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发表时间：
1992-01-01
影响因子：
7
通讯作者：
FINEBERG, B
中科院分区：
文献类型：
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作者：
HALVERSON, KJ;PEREZ, CA;FINEBERG, B
虽然乳腺癌局部复发的预后变量已经通过单因素分析进行了评估，但以前还没有进行过多因素分析。在这项研究中，对230名在Mallinckrodt放射研究所及其附属医院接受放射肿瘤学中心、Mallinckrodt放射研究所和附属医院治疗的无远处转移证据的局部区域复发乳腺癌患者的胸壁和/或区域淋巴复发后的存活率进行了测定。多因素分析表明，复发部位与总生存率的相关性最强(p=0.001)。对于孤立的胸壁、腋窝和内乳房淋巴结复发的患者，5年精算总存活率为44-49%。锁骨上、多发性淋巴管或伴有胸壁和淋巴管复发的患者5年总存活率为21-24%。胸壁、腋窝或内乳房复发的患者的5年无瘤生存率为28-37%，而锁骨上、胸壁和淋巴管复发或多部位淋巴复发的患者的5年无瘤生存率为4-13%。从乳房切除到复发的无病间隔也被发现是影响总存活率的重要预后因素(p=0.005)。在无病间隔至少2年的患者中，50%的患者在局部区域复发后存活了5年，相比之下，无病间隔不到2年的患者中有35%的患者存活了5年。在胸壁复发(切除或<3厘米)且无病间隔至少2年的患者中，5年总存活率和无病存活率分别为67%和54%。这些结果表明，乳腺癌局部复发的患者亚群可以长期存活。传统的观点认为，乳腺癌切除后胸壁和/或区域结节复发都意味着预后不佳，这一观点并不一定正确。
Although prognostic variables for locoregional recurrence of breast cancer have been evaluated by univariate analysis, multifactorial analysis has not been previously performed. In the present study, survival following chest wall and/or regional lymphatic recurrence was determined in 230 patients with locoregionally recurrent breast cancer without evidence of distant metastases treated at the Radiation Oncology Center, Mallinckrodt Institute of Radiology and affiliated hospitals. Multifactorial analysis demonstrated that the site of recurrences correlated most strongly with overall survival (p = 0.001). The 5-year actuarial overall survival was 44-49% for patients with isolated chest wall, axillary, and internal mammary lymph node recurrence. Patients with either supraclavicular, multiple lymphatic, or concomitant chest wall and lymphatic recurrence had an 21-24% 5-year overall survival. The 5-year disease-free survival was 28-37% for patients with chest wall, axillary, or internal mammary recurrences compared to 4-13% for those with supraclavicular, chest wall and lymphatic, or those with multiple sites of lymphatic recurrence. Disease-free interval from mastectomy to recurrence was also found to be a significant prognostic factor for overall survival (p = 0.005). Fifty percent of patients with a disease-free interval of at least 2 years survived 5 years following locoregional relapse, compared to 35% for those with disease-free interval of less than 2 years. In the subset of patients with small chest wall recurrences (excised or < 3 cm) and a disease-free interval of at least 2 years, the 5-year overall and disease-free survivals were 67% and 54%, respectively. These results suggest that subsets of patients with locoregional recurrence of breast cancer can survive for long periods of time. The conventional wisdom that chest wall and/or regional nodal recurrence following mastectomy uniformly confers a dismal prognosis is not necessarily true.