Beyond palliative mastectomy in inflammatory breast cancer - A reassessment of margin status
Beyond palliative mastectomy in inflammatory breast cancer - A reassessment of margin status
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DOI：
10.1007/s10434-999-0249-3
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发表时间：
1999-04-01
影响因子：
3.7
通讯作者：
Wagman, LD
中科院分区：
文献类型：
--
作者：
Curcio, LD;Rupp, E;Wagman, LD
背景：炎性乳腺癌是一种局部晚期肿瘤，具有侵袭性的局部和全身病程。在过去的几十年里，这种疾病的治疗一直在不断发展。本研究的目的是评估当前的治疗方法（包括手术治疗和化疗）是否能提供更好的局部控制（LC）和总体生存（OS）。我们还试图确定可能与改善 OS、无病生存 (DFS) 和 LC 相关的临床和病理因素。方法：在希望之城国家医疗中心进行的 25 年回顾性审查确定了 90 名诊断为炎性乳腺癌的患者。结果：在 90 名确诊为炎性乳腺癌的患者中，33 人接受了新辅助治疗 (NEO)，包括化疗和随后的化疗。 有辐射的手术 (n = 26) 和无辐射的手术 (n = 7)。 57 名患者接受了其他治疗（非 NEO）。非NEO组接受的治疗包括单独或联合化疗、放疗、乳房切除术、肾上腺切除术和卵巢切除术。 NEO 组的中位随访时间为 28.9 个月，非 NEO 组的中位随访时间为 17.6 个月。两组之间的 OS 分布存在显着差异 (P = .10)，NEO 组的 3 年和 5 年 OS 分别为 40.0% 和 29.9%，非 NEO 组分别为 24.7% 和 16.5%。两组的 DFS 和 LC 相当。较低的分期与 OS 的改善相关 (P < .05)。 IIIB 期的 5 年 OS 为 30.9%，而 TV 期为 7.8%。在接受乳房切除术治疗并痊愈的 III 期疾病患者中，通过单变量分析确定切缘状态是 OS 的预后指标 (P < .05)。切缘阴性患者的 3 年 OS、DFS 和 LC 分别为 47.4%、37.5% 和 60.3%，而切缘阳性患者的 3 年 OS、DFS 和 LC 分别为 0%、16.7% 和 31.3%。 结论：本研究表明，对于炎性乳腺癌和非转移性疾病患者，以手术切缘阴性为目标，采用积极的手术方法可能是合理的。这种局部控制的实现与这部分患者的更好的总体结果相关。获得负切缘的能力可以进一步识别一组具有较低侵袭性肿瘤生物学特性的患者，这些患者可能对其他治疗方式更敏感。
Background: Inflammatory breast cancer is a locally advanced tumor with an aggressive local and systemic course. Treatment of this disease has been evolving over the last several decades. The aim of this study was to assess whether current therapies, both surgical and chemotherapeutic, are providing better local control (LC) and overall survival (OS). We also attempted to identify clinical and pathologic factors that may be associated with improved OS, disease-free survival (DFS), and LC.Methods: A 25-year retrospective review performed at the City of Hope National Medical Center identified 90 patients with the diagnosis of inflammatory breast cancer.Results: Of the 90 patients identified with inflammatory breast cancer, 33 received neoadjuvant therapy (NEO) consisting of chemotherapy followed by surgery with radiation (n = 26) and without radiation (n = 7). Fifty-seven patients received other therapies (nonNEO). Treatments received by the nonNEO group consisted of chemotherapy, radiation, mastectomy, adrenalectomy, and oophorectomy, alone or in combination. The median follow-up was 28.9 months for the NEO group and 17.6 months for the nonNEO group. Borderline significant differences in the OS distributions between the two groups were found (P = .10), with 3- and 5-year OS for the NEO group of 40.0% and 29.9% and for the nonNEO group of 24.7% and 16.5%, respectively. DFS and LC were comparable in the two groups. Lower stage was associated with an improved OS (P < .05). The 5-year OS for stage IIIB was 30.9%, compared to 7.8% for stage TV. In those patients with stage III disease who were treated with mastectomy and rendered free of disease, margin status was identified by univariate analysis to be a prognostic indicator for OS (P < .05). The 3-year OS, DFS, and LC for patients with negative margins were 47.4%, 37.5%, and 60.3%, respectively, compared to 0%, 16.7%, and 31.3% in patients with positive margins.Conclusions: This study suggests that in patients with inflammatory breast cancer and nonmetastatic disease, an aggressive surgical approach may be justified with the goal of a negative surgical margin. Achievement of this local control is associated with a better overall outcome for this subset of patients. The ability to obtain negative margins may further identify a group of patients with a less aggressive tumor biology that may be more responsive to other modalities of therapy.