Repeating Conservative Surgery after Ipsilateral Breast Tumor Reappearance: Criteria for Selecting the Best Candidates
Repeating Conservative Surgery after Ipsilateral Breast Tumor Reappearance: Criteria for Selecting the Best Candidates
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DOI：
10.1245/s10434-012-2404-5
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发表时间：
2012-11-01
影响因子：
3.7
通讯作者：
Veronesi, Umberto
中科院分区：
文献类型：
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作者：
Gentilini, Oreste;Botteri, Edoardo;Veronesi, Umberto
乳腺切除术仍然是保乳手术（BCS）和全乳放疗后同侧乳腺肿瘤复发（IBTR）患者的首选治疗方法。我们回顾性评估了161例接受第二次BCS的侵袭性IBTR患者，以描述预后，确定预后的预测因素，并选择局部控制最佳的患者亚组。IBTR后的中位随访时间为81个月，IBTR时的中位年龄为53岁。IBTR后的5年总生存率为84%（95%置信区间[CI] 78-89）。IBTR后第二次局部事件的5年累积发生率为29%（95%CI 22-37）。在多变量分析中，IBTR大小> 2 cm和复发时间为千分之一货币符号48个月显著增加了局部复发的风险（风险比[HR] 3.3，95%CI 1.6-7.0; HR 1.9，95%CI 1.1-3.5）。重复BCS后肿瘤进一步局部复发的5年累积发生率在IBTR <2cm且至IBTR时间> 48个月的患者中为15.2%，在IBTR <2cm且至IBTR <48个月的患者中为31.2%，IBTR > 2cm者为71.2%（P < 0.001），IBTR小（<2cm）和IBTR晚（> 48个月）者为再次BCS的最佳选择。在决策过程中，应与患者分享重复BCS后进一步局部复发风险的信息。
Mastectomy is still considered the treatment of first choice in patients with ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) and whole-breast radiotherapy.We retrospectively evaluated 161 patients with invasive IBTR who underwent a second BCS in order to describe prognosis, determine predictive factors of outcome, and select the subset of patients with the best local control. Median follow-up after IBTR was 81 months.Median age at IBTR was 53 years. Five-year overall survival after IBTR was 84 % (95 % confidence interval [CI] 78-89). Five-year cumulative incidence of a second local event after IBTR was 29 % (95 % CI 22-37). At the multivariate analysis, IBTR size > 2 cm and time to relapse a parts per thousand currency sign48 months significantly increased the risk of local reappearance (hazard ratio [HR] 3.3, 95 % CI 1.6-7.0; and HR 1.9, 95 % CI 1.1-3.5). The 5-year cumulative incidence of a further local reappearance of the tumor after repeating BCS was 15.2 % in the patients with IBTR a parts per thousand currency sign2 cm and time to IBTR > 48 months, 31.2 % in the patients with IBTR a parts per thousand currency sign2 cm and time to IBTR a parts per thousand currency sign48 months, and 71.2 % in patients with IBTR > 2 cm (P < 0.001).The best candidates for a second BCS are those with small (a parts per thousand currency sign2 cm) and late (> 48 months) IBTR. The information about the risk of a further local reappearance after repeating BCS should be shared with the patients in the decision making process.