保乳术后同侧乳腺癌复发的治疗选择

　　保乳治疗已被越来越多地用于原发可手术乳腺癌，其肿瘤学结局与乳房切除相似。不过，对于保乳术后同侧乳腺肿瘤复发患者，尚不明确是否适合再次保乳，故通常推荐行乳房切除。

　　2021年1月12日，自然施普林格旗下《乳腺癌研究与治疗》在线发表美国纽约纪念医院斯隆凯特林癌症中心的研究报告，对保乳术后同侧乳腺肿瘤复发再次保乳与乳房切除进行了比较。该中心旧称纽约肿瘤医院，成立于1884年，是全世界成立最早和规模最大的私立肿瘤医院。

　　该单中心回顾研究对1999～2019年进行保乳治疗的1万6968例乳腺浸润癌或导管原位癌女性进行回顾分析，对首先发生同侧乳房肿瘤复发后，再次保乳与乳房切除的后续事件和生存结局进行比较。

　　结果，322例（1.9%）发生孤立性同侧乳腺肿瘤复发，其中130例（40%）再次保乳、其余192例（60%）乳房切除。

　　再次保乳与乳房切除相比：

  • 中位年龄较大（66岁比53岁，<0.001）

  • 无病间隔较长（5.8年比2.7年，P<0.001）

  • 放疗比例较低（P<0.001）

  • 内分泌治疗比例较低（P<0.005）

  • 放疗＋内分泌治疗比例较低（P<0.001）

  • 原发肿瘤特征相似

  • 同侧乳腺肿瘤复发特征相似

　　首次保乳治疗中位随访10.7年、同侧乳房肿瘤复发中位随访6.5年，再次保乳与乳房切除相比，乳腺癌相关生存或总生存结局相似。

　　因此，该单中心回顾研究结果表明，对于保乳治疗首先发生同侧乳腺肿瘤复发患者，从首次保乳治疗或同侧乳腺肿瘤复发开始，无论再次保乳还是乳房切除，乳腺癌相关生存或总生存结局相似。这些结果支持对于同侧乳腺肿瘤复发患者（尤其年龄较大或无病间隔较长患者）更多考虑保乳治疗。

Breast Cancer Res Treat. 2021 Jan 12. Online ahead of print.

Management of ipsilateral breast tumor recurrence following breast conservation surgery: a comparative study of re-conservation vs mastectomy.

Van den Bruele AB, Chen I, Sevilimedu V, Le T, Morrow M, Braunstein LZ, Cody HS 3rd.

Memorial Sloan Kettering Cancer Center, New York, NY, USA.

BACKGROUND: Breast conservation therapy (BCT) is well established for the management of primary operable breast cancer, with oncologic outcomes comparable to those of mastectomy. It remains unclear whether re-conservation therapy (RCT) is suitable for those patients who develop ipsilateral breast tumor recurrence (IBTR), for whom mastectomy is generally recommended.

METHODS: We identified women who underwent BCT for invasive or ductal carcinoma in situ and developed IBTR as a first event, comparing the pattern of subsequent events and survival for those treated by RCT versus mastectomy.

RESULTS: Of 16,968 patents who had BCT, 322 (1.9%) developed an isolated IBTR as a first event between 1999 and 2019. 130 (40%) had RCT and 192 (60%) mastectomy. Compared to mastectomy, the RCT patients were older (66 vs 53, < 0.001), had a longer disease-free interval (DFI: 5.8 vs 2.7 years (p < 0.001)), were less likely to have received RT (p < 0.001), endocrine therapy (ET) (p < 0.005) or combined RT/ET (< 0.001) as initial treatment, but the characteristics of their initial primary cancers and of their IBTR were comparable. At a median follow-up of 10.7 years following initial BCT and 6.5 years following IBTR, there were no differences in BCSS or OS between RCT and mastectomy.

CONCLUSION: For BCT patients who developed IBTR as a first event, we observed comparable BCSS and OS from time of initial treatment and from time of IBTR, whether treated by RCT or mastectomy. These results support wider consideration of RCT in the management of IBTR, especially in the setting of older age and longer DFI.

KEYWORDS: Breast cancer; Breast conserving surgery; Ipsilateral breast tumor recurrence; Mastectomy; Re-conservation

PMID: 33433775

DOI: 10.1007/s10549-020-06080-9

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