Local Recurrence and Breast Oncological Surgery in Young Women With Breast Cancer: The POSH Observational Cohort Study.
Local Recurrence and Breast Oncological Surgery in Young Women With Breast Cancer: The POSH Observational Cohort Study.
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DOI：
10.1097/sla.0000000000001930
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发表时间：
2017-07
影响因子：
9
通讯作者：
Eccles DM
中科院分区：
文献类型：
--
作者：
Maishman T;Cutress RI;Hernandez A;Gerty S;Copson ER;Durcan L;Eccles DM
在散发性与遗传性乳腺癌（POSH）预后的前瞻性研究中，评估影响年轻乳腺癌患者局部复发和生存的临床和手术因素。新出现的数据表明，年轻是局部复发增加的一个预测因素。POSH是一项前瞻性队列研究，包括3024名18至40岁的乳腺癌患者。队列特征按乳房切除术或BCS分组。终点为局部复发期（LRI）、远端无病期（DDFI）和总生存期（OS）；使用累积风险和Kaplan-Meier图以及灵活参数和Cox回归模型的多变量分析进行描述。1464例患者行乳房切除术，1395例行保乳手术。乳房切除术患者肿瘤较大，阳性家族史、雌激素受体+、孕激素受体+和/或人表皮生长因子受体2+肿瘤比例较高。本地事件占复发的15%。手术类型的LRI随时间而变化，18个月时LRI相似（1.0% vs 1.0%, P = 0.348），但5年和10年时BCS的LRI更高（5.3% vs 2.6%, P < 0.001; 11.7% vs 4.9%, P < 0.001）。在调整后的模型中也发现了类似的结果。相反，BCS的远处转移和死亡率较低，但在调整预后因素后并非如此。乳房切除术后胸壁放疗与LRI改善相关（风险比，HR = 0.46, P = 0.015）。手术切缘阳性和局部复发预测DDFI降低（HR = 0.50, P < 0.001; HR = 0.29, P = 0.001）。对于DDFI，手术范围似乎不如切除的完整性或胸壁放射治疗重要。尽管BCS的局部复发率较高，但在调整已知预后因素后，手术类型对年轻乳腺癌患者的DDFI或OS没有影响。
Supplemental Digital Content is available in the text To assess clinical and surgical factors affecting local recurrence and survival in young breast cancer patients in the Prospective study of Outcomes in Sporadic versus Hereditary breast cancer (POSH). Emerging data suggest young age is a predictor of increased local recurrence. POSH is a prospective cohort of 3024 women of 18 to 40 years with breast cancer. Cohort characteristics were grouped by mastectomy or BCS. Endpoints were local-recurrence interval (LRI), distant disease-free interval (DDFI), and overall survival (OS); described using cumulative-hazard and Kaplan-Meier plots and multivariable analyses by Flexible Parametric and Cox regression models. Mastectomy was performed in 1464 patients and breast-conserving surgery (BCS) in 1395. Patients undergoing mastectomy had larger tumors and higher proportions of positive family history, estrogen receptor+, progesterone receptor+, and/or human epidermal growth factor receptor 2+ tumors. Local events accounted for 15% of recurrences. LRI by surgical type varied over time with LRI similar at 18 months (1.0% vs 1.0%, P = 0.348) but higher for BCS at 5 and 10 years (5.3% vs 2.6%, P < 0.001; and 11.7% vs 4.9%, P < 0.001, respectively). Similar results were found in the adjusted model. Conversely, distant-metastases and deaths were lower for BCS but not after adjusting for prognostic factors. After mastectomy chest-wall radiotherapy was associated with improved LRI (hazard ratio, HR = 0.46, P = 0.015). Positive surgical margins, and development of local recurrence predicted for reduced DDFI (HR = 0.50, P < 0.001; and HR = 0.29, P = 0.001, respectively). Surgical extent appears less important for DDFI than completeness of excision or, where appropriate, chest-wall radiotherapy. Despite higher local-recurrence rates for BCS, surgical type does not influence DDFI or OS after adjusting for known prognostic factors in young breast cancer patients.