Oncoplastic breast conservation surgery is oncologically safe when compared to wide local excision and mastectomy
Oncoplastic breast conservation surgery is oncologically safe when compared to wide local excision and mastectomy
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DOI：
10.1016/j.breast.2017.02.006
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发表时间：
2017-04-01
期刊：
影响因子：
3.9
通讯作者：
Romics, L.
中科院分区：
文献类型：
--
作者：
Mansell, J.;Weiler-Mithoff, E.;Romics, L.
背景资料：支持肿瘤整形保乳手术（OBCS）的肿瘤学安全性主要是基于OBCS与广泛局部切除术（WLE）后复发率的比较证据。然而，OBCS通常适用于较大的癌症，肿瘤学结果也应与乳房切除术治疗的患者进行比较。在这项研究中，我们比较了复发和生存以下OBCS，乳房切除术和WLE.Methods：患者治疗OBCS 2009年和2012年之间的前瞻性维护数据库中确定。为了进行比较，确定了在同一时间段内接受WLE或乳房切除术（伴或不伴立即重建（Ms +/- IR））治疗的连续患者。采用Fisher精确检验或卡方检验比较患者的组织学变量，采用Kaplan-Meier和考克斯回归生存分析比较复发和生存。结果：分析了980例患者的数据（OBCS：n = 104; WLE：n = 558; MS +/- IR：n = 318）。与WLE治疗的患者相比，OBCS治疗的患者的肿瘤大小、分级、淋巴结状态、ER和PR表达均显著更不利（p < 0.001）。这些组织学变量在接受Ms IR和OBCS治疗的患者中相似。三组的5年局部复发率相似（WLE：3.4%，OBCS：2%，MS +/- IR：2.6%;对数秩= 0.973），而MS +/- IR和OBCS后的远处复发率更高（MS +/- IR：13.1%，OBCS：7.5%，WLE：3.3%;对数秩：p < 0.001）。即使组织学结果与接受Ms +/-IR治疗的患者相似，OBCS在患者中也具有肿瘤安全性。（C）2017 Elsevier Ltd.保留所有权利。
Background: Support for the oncological safety of oncoplastic breast conservation surgery (OBCS) is mostly based on evidence comparing recurrence rates after OBCS to wide local excision (WLE). However, OBCS is often indicated for larger cancers and oncological results should also be compared to patients treated with mastectomy. In this study we compared recurrence and survival following OBCS, mastectomy and WLE.Methods: Patients treated with OBCS between 2009 and 2012 were identified from a prospectively maintained database. For comparison, consecutive patients treated with WLE or mastectomy with or without immediate reconstruction (Ms +/- IR) over the same time period were identified. Histological variables of patients were compared using Fisher Exact or Chi squared tests, and recurrence and survival were compared using Kaplan-Meier and Cox regression survival analysis.Results: 980 patients' data were analysed (OBCS: n = 104; WLE: n = 558; Ms +/- IR: n = 318). Tumour size, grade, nodal status, ER, and PR expression of patients treated with OBCS were all significantly more adverse compared with patients treated with WLE (p < 0.001). These histological variables were similar in patients treated with Ms IR and OBCS. 5 -year local recurrence rates were similar in all three groups (WLE: 3.4 per cent, OBCS: 2 per cent, Ms +/- IR: 2.6 per cent; log rank = 0.973), while distant recurrence rates were higher after Ms +/- IR and OBCS (Ms +/- IR:13.1 per cent, OBCS:7.5 per cent, WLE:3.3 per cent; log rank: p < 0.001).Conclusion: OBCS is oncologically safe in patients even when histological results are similar to patients treated with Ms +/- IR. (C) 2017 Elsevier Ltd. All rights reserved.