Prognostic Factors of Local-Regional Recurrence after Breast-Conserving Surgery and Radiation Therapy With/Without Chemotherapy for Early Breast Cancer

初期乳癌病人接受乳房保留治療局部復發因子之分析研究

劉名浚(Mirrorer Mng-Jiung Liu) ； 呂美君(Mei-Chun Lu) ； 陳啟明(Chii-Ming Chen) ； 林寬仁(Christopher K. J. Lin) ； 曹美華(Mei-Hua Tsou) ； 蔡玉真(Stella Y. C. Tsai) ； 鄭鴻鈞(Skye H. Cheng) ； 簡哲民(James J. Jian)

《放射治療與腫瘤學》 15卷1期 (2008/03) Pp. 1-8

https://doi.org/10.6316/TRO/200815(1)1

摘要

目的：本回溯性研究的目的在於報告本院初期乳癌病人接受乳房保留治療之成果，並分析疾病復發之危險因子。
材料與方法：本院於1990年至2002年間共有374位初期乳癌病人接受乳房保留手術合併術後放射線治療，其中285位(76%)之局部期別為T、89位(24%)為T2，有87位病人(23%)同時有腋下淋巴結轉移，接受術後化學治療的病人有28位(75%)。放射治療的劑量中位數為患側全乳房給予46葛雷之後再給予局部加強6葛雷。存活率的曲線是以Kaplan-Miere方法繪製，同時以Chi-square或Fisher's exact test找尋可能的危險因子。
結果：在追蹤時間中位數為4.2年的情況下總共有6位病人發生了局部復發(其中11位僅有同側乳房或淋巴結局部復發，5位於確認復發時合併有遠端轉移)；5年的無病存活率為87.9%，無局部復發率為95%。局部復發的危險因子包括了：發病年齡小於40歲、multifocal or multicentric disease（多發性）以及positive or close surgical margin（手術乾淨邊緣不足）。所有10位僅有患側乳房局部復發的病人在接受了乳房根除手術後於持續追蹤中均為無病存活的狀態（追蹤時間9~34個月，中位數60個月）。
結論：乳房保留手術合併術後放射線治療能夠提供初期乳癌病人合理的治療結果，但是對於疾病局部復發的高危險群（如：發病年齡小於40歲、多發性以及手術乾淨邊緣不足）病人應給予更為密集地追蹤。

關鍵字

初期乳癌 ； 乳房保留治療 ； 放射治療 ； 局部復發

並列摘要

Purpose: This retrospective study is to report the results of breast-conserving treatment and analyze the prognostic factors of local-regional recurrence (LRR) of early breast cancer in a single institute.
Materials and Methods: Between 1990 and 2002, 374 women of non-metastatic invasive breast cancer received breast-conserving surgery followed by post-operative radiotherapy (RT) with or without chemotherapy at the Koo Foundation Sun Yat-Sen Cancer Center. Of the 374 patients, 285 (76%) had pathologic Ti disease and 89 (24%) T2 disease. Eighty-seven (23%) patients were found to have pathologic involvement of axillary lymph nodes. Two hundred and eighty-one patients (75%) have received adjuvant chemotherapy. The median dose of RT was 46 Gy in 23 fractions to the breast with/without supraclavicular area and internal mammary chain followed by tumor bed boost of 16 Gy. The medical records including pathologic reports were reviewed for analysis of tumor recurrence.
Results: There were 16 local and/or regional recurrences (11 LRR only; 5 LRR with distant metastasis) after a median follow-up of 4.2 years. The 5-year disease-free, LRR-free and overall survivals were 87.9%, 95% and 94.1% respectively. The risk factors of LRR include age equal to or less than 40 years old, multifocal or multicentric disease, and positive or close surgical margin. All 10 patients with ipsilateral breast tumor recurrence only were still alive without disease after salvage simple mastectomy (range, 9~134 months; median 60 months).
Conclusion: Breast-conserving surgery followed by RT provided excellent local-regional control for early breast cancer. Patients with risk factors of young age, close/positive margin, and multifocal/multicentric disease need to be followed closely.

並列關鍵字

Early breast cancer ； Breast-conserving therapy ； Radiotherapy ； Local-regional recurrence