Ipsilateral breast tumor recurrence and survival following lumpectomy and irradiation: pathological findings from NSABP protocol B-06.
Ipsilateral breast tumor recurrence and survival following lumpectomy and irradiation: pathological findings from NSABP protocol B-06.
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发表时间：
1992-05
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通讯作者：
Edwin R. Fisher;Stewart J. Anderson;C. Redmond;B. Fisher
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作者：
Edwin R. Fisher;Stewart J. Anderson;C. Redmond;B. Fisher
在NSABP方案B-06中登记的488名病理可评估的患者中，有42名(9%)发生了同侧乳腺肿瘤复发(IBTR)，在I期和II期浸润性乳腺癌接受肿块切除和局部乳腺放射治疗(LXRT)后，平均随访103个月(范围68-161个月)。IBTR位于或接近指标癌的同一象限，它们的组织类型和核分级即使不相同，也有95%相似。这一信息证实了我们早先的发现，即多中心性对LXRT治疗乳腺癌的临床意义很小或没有临床意义；乳腺癌一旦临床检测到，其生物学潜力很少改变；最后，大多数(如果不是全部)IBTR代表残留癌。COX回归分析显示，只有年龄小于35岁的患者与肠易激综合征显著相关。未发现IBTR与所谓的广泛导管内成分(EIC)或指标癌的其他31个病理特征之间的关系。总生存率与结节状态(P=0.0 1)、核级别(P=<0.001)、组织学类型(P=0.0 1)和IBTR值(P=<0.001)显著相关。后者被认为是远处疾病和生存率下降的指标而不是煽动者，因为后者在接受LXRT、单纯肿块切除术(之后IBTR更频繁)或乳房切除术(排除其表达)的患者中没有什么不同。我们的结论是，到目前为止，还没有可行的标记物来禁忌LXRT治疗乳腺癌患者。
Ipsilateral breast tumor recurrence (IBTR) occurred in 42 of 488 (9%) pathologically evaluable patients enrolled in NSABP protocol B-06 with a mean potential follow-up of 103 months (range 68-161 months) following treatment for Stage I and II invasive breast cancer by lumpectomy and local breast irradiation (LXRT). IBTR were observed at or close to the same quadrant as the index cancers and their histologic types and nuclear grades were similar if not identical in 95 and 93%, respectively. This information confirms our earlier findings which indicated that multicentricity is of little or no clinical significance in the treatment of breast cancer by LXRT; breast cancers rarely if ever change their biologic potential once clinically detected; and lastly, most if not all IBTR represent residual cancer. Cox regression analyses revealed only a patient age less than 35 years to be significantly related to IBTR. No relationship between IBTR and so-called extensive intraductal component (EIC) or 31 other pathologic features of the index cancers was found. Overall survival was significantly related to nodal status (P = 0.01), nuclear grade (P = less than 0.001) histologic tumor type (P = 0.01) and IBTR (P = less than 0.001). This latter was considered as an indicator rather than instigator of distant disease and reduced survival since the latter is no different in patients treated by LXRT, lumpectomy alone after which IBTR is much more frequent, or mastectomy, which precludes its expression. We conclude that there are as yet no viable markers which would contraindicate treating patients with breast cancer by LXRT.