ASCO2012：MF和MC不是乳腺癌局部复发的独立危险因素

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ASCO2012：MF和MC不是乳腺癌局部复发的独立危险因素
2012-06-07
背景：多灶性(MF)和多中心性(MC)侵袭性乳腺癌的局部控制情况以及对这些肿瘤局部治疗策略的影响尚不明确。特别是目前文献中关于保乳治疗的应用并未达成一致意见。我们开展了一项关于多灶性和多中心性乳腺癌的大的单中心队列研究，该研究的目的是评价与单灶性乳腺癌相比，MF和MC是否具有更差的局部控制率。

方法：MF和MC分别定义为：同一象限内有1个以上病灶和不同象限内有1个以上的病灶。应用Cox比例风险模型来确定MF/MC疾病与局部控制率的独立相关性。其中10位接受BCT的MC患者因不接受医生建议而排除。MF和MC肿瘤患者被作为一组以及分为不同的组别进行了分析。根据患者是否存在MF或MC进行分组，以及根据局部治疗模式分组：保乳手术治疗组(256例)，单纯乳房切除术组(466例)和乳房切除术加术后放疗组(184例)。

结果：中位随访期为52个月。在3722名分期为I-III期，且未接受过新辅助化疗的患者中，906名(24%)患者具有多发病变，其中MF有673名，另外233名为MC。MF组5年局部控制率为99%，MC组为96%，而在单一病变组为98%，(P =0.44)。亚组分析提示不同局部治疗方式的各组间的局部控制情况无统计学差异。在保乳治疗组，有21位患者出现乳腺内复发(8.2%)。在控制了其他危险因素后，MF和MC并未显示对局部控制率具有独立的影响作用。

结论：MF和MC不是局部复发的独立危险因素。MF和MC乳腺癌患者具有与单灶性的乳腺癌患者相同的局部控制率，且与局部治疗模式无关。我们的数据提示对于MF肿瘤来说保乳手术是一种安全的选择。MF或MC本身并不是乳腺切除术后需进行放射治疗的指征。

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Breast cancer multifocality-multicentricityand locoregional recurrance.

Background: The impact of multifocality(MF) and multicentricity (MC) on locoregional (LR) control for invasive breastcancer, and the optimal local treatment strategy for these tumors, is unknown.In particular, there is disagreement in the literature regarding the use ofBreast Conservation Therapy (BCT). We evaluated a large single institutioncohort of MF and MC breast cancers to determine if they had inferior LR controlrate when compared to their unifocal counterparts. Methods: MF and MC weredefined pathologically as more than one lesion in the same quadrant and morethan one lesion in separate quadrants, respectively. Patients were categorizedby presence or absence of MF or MC disease and by the LR treatment modalityreceived – BCT (n5256), mastectomy alone (n5466), or mastectomy plus post-mastectomyradiation therapy (n5184). 10 patients who underwent BCT for MC disease againstphysician advice were excluded. MF and MC tumors were analyzed both as a groupand as separate entities. Kaplan-Meier product limit method was used tocalculate 5-year LR control rate. Cox proportional hazards models were fit todetermine independent associations of MF/MC disease with LR control. Results:Median follow up was 52 months. Out of 3722 patients with stage I-III diseasewho did not receive neoadjuvant chemotherapy, 906 (24%) had MF (n5673) or MC(n5233) disease. 5-year rate of LR control rate was 99% in the MF group, 96% inthe MC group, and 98% in the unifocal group, (P 5 0.44). Subset analysisrevealed no statistical difference in LR control regardless of the type of LRtreatment, (P 5 0.67 in the BCT group, P 5 0.37 in the mastectomy alone group,and P 5 0.29 in the mastectomy plus post-mastectomy radiation therapy group).There were 21 in-breast recurrences after BCT (8.2%). After controlling forother risk factors, MF and MC did not have an independent impact on LR controlrate. Conclusions: MF and MC disease are not independent risk factors for LRrecurrence. Patients with MF and MC breast cancer had similar rates of LRcontrol to their unifocal counterparts, regardless of LR treatment modality.Our data suggest that BCT is a safe option for patients with MF tumors and thatMF or MC disease alone is not an indication for post-mastectomy radiationtherapy.