Risk factors for local recurrence after breast-conserving surgery
Risk factors for local recurrence after breast-conserving surgery
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DOI：
10.1002/bjs.4206
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发表时间：
2003-09-01
影响因子：
9.6
通讯作者：
Frisell, J
中科院分区：
文献类型：
--
作者：
Fredriksson, I;Liljegren, G;Frisell, J
背景：保乳手术后局部复发的风险因素在原位癌和浸润性癌手术女性中是否存在差异尚不清楚。此外，诺丁汉预后指数（NPI）和诺丁汉组织学分级（NHG）作为局部复发风险的决定因素很少被研究。
方法：在一项病例对照研究（491例病例和1098例对照）中，该研究嵌套在一个由7502名接受过乳腺原位癌或浸润性癌手术的女性组成的队列中，患者特征、肿瘤特征和治疗相关变量被评估为局部复发的风险因素。
结果：多变量条件逻辑回归分析显示，年龄小于40岁、肿瘤多中心性以及手术切缘不明确或未知是局部复发的重要风险因素。乳房放疗和辅助激素治疗具有保护作用。原位癌与浸润性癌相比，局部复发风险并未升高（比值比为1.0，95%置信区间为0.8 - 1.3）。NHG和NPI对确定局部复发风险没有帮助。
结论：切缘状态、年龄、肿瘤多中心性以及放疗和辅助激素治疗的使用是局部复发风险的重要决定因素。除手术切缘外，与手术管理质量相关的变量不能预测局部复发风险。
Background: It is not clear whether risk factors for local recurrence after breast-conserving surgery differ in women having surgery for in situ or invasive cancer. Furthermore, the Nottingham Prognostic Index (NPI) and Nottingham Histological Grade (NHG) have been little studied as determinants of local recurrence risk.Method: In a case-control study (491 cases and 1098 controls) nested within a cohort of 7502 women who had surgery for in situ or invasive cancer of the breast, patient characteristics, tumour characteristics and treatment-related variables were evaluated as risk factors for local recurrence.Results: Multivariate conditional logistic regression analyses showed that age below 40 years, tumour multicentricity and an unclear or unknown surgical margin were significant risk factors for local recurrence. Radiotherapy to the breast and adjuvant hormone therapy were protective. Cancer in situ was not associated with a higher risk of local recurrence than invasive cancer (odds ratio 1.0, 95 per cent confidence interval 0.8 to 1.3). NHG and NPI were not helpful in determining risk of local recurrence.Conclusion: Margin status, age, tumour multicentricity, and use of radiotherapy and adjuvant hormone therapy were important determinants of risk of local recurrence. With the exception of surgical margin, variables related to the quality of surgical management did not predict risk of local recurrence.