保乳手术后局部区域复发时空特征

　　对于早期乳腺癌，保乳手术已被确立为治疗标准之一。不过，保乳手术后的局部区域复发仍然是临床实践经常遇到的问题，而且其时间、空间分布各不相同，生物学行为、生存结局具有显著差异。

　　2021年8月30日，瑞士《肿瘤学前沿》在线发表复旦大学附属肿瘤医院瞿飞麟、茅锐、刘哲斌、林偲进、曹阿勇、吴炅、柳光宇、余科达、狄根红、李俊杰、邵志敏等学者的研究报告，对10年4325例早期乳腺癌患者保乳手术后局部区域复发的时空特征进行了分析。

　　该单中心大样本回顾研究对2006～2016年在复旦大学附属肿瘤医院进行保乳手术前未予新辅助治疗的4325例早期单侧乳腺浸润癌女性患者数据进行回顾分析。采用多因素比例风险回归模型对临床病理因素和治疗方案因素进行分析，以确定可预测局部区域复发事件的影响因素。根据复发类型和无复发间隔，对复发方式进一步分析。根据复发类型和分子亚型，对年复发率进行比较。

　　结果，中位随访66个月期间，首先发生局部区域复发120例（2.8%），首先发生远处复发142例（3.3%）。

　　年龄、病理分期、分子亚型被确定为局部区域复发的预测因素。

　　主要复发类型为同侧乳腺肿瘤复发，主要（83.6%）发生于手术后≤5年。对于总体人群，年复发率曲线表明复发于手术后前2.5年达到峰值。

　　区域淋巴结复发、无复发间隔较短、同时远处转移的患者生存结局较差。

　　HER2阳性激素受体阴性乳腺癌的局部区域复发率较高、乳房内复发率较高、手术后前2年复发达到峰值。

　　因此，该单中心大样本回顾研究结果表明，对于中国早期乳腺癌患者，保乳手术后的局部区域复发风险普遍较低。保乳手术后不同的复发方式，与不同的临床结局显著相关。局部区域复发的管理应充分个体化，并根据病变程度、复发分子特征、基线临床因素进行调整。

Front Oncol. 2021 Aug 30;11:690658.

Spatiotemporal Patterns of Loco-Regional Recurrence After Breast-Conserving Surgery.

Qu FL, Mao R, Liu ZB, Lin CJ, Cao AY, Wu J, Liu GY, Yu KD, Di GH, Li JJ, Shao ZM.

Fudan University Shanghai Cancer Center, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China.

BACKGROUND: Loco-regional recurrences (LRR) following breast-conserving surgery (BCS) remain a heterogeneous class of disease that has significant variation in its biological behavior and prognosis.

METHODS: To delineate the spatiotemporal patterns of LRR after BCS, we analyzed the data of 4325 patients treated with BCS from 2006 to 2016. Clinico-pathological and treatment specific factors were analyzed using the Cox proportional hazards model to identify factors predictive for LRR events. Recurrence patterns were scrutinized based on recurrence type and recurrence-free interval (RFI). Annual recurrence rates (ARR) were compared according to recurrence type and molecular subtype.

RESULTS: With a median follow-up of 66 months, 120 (2.8%) LRRs were recorded as the first site of failure. Age, pathologic stage, and molecular subtype were identified as predictors of LRR. The major recurrence type was ipsilateral breast tumor recurrence, which mainly (83.6%) occurred ≤5y post surgery. In the overall population, ARR curves showed that relapse peaked in the first 2.5 years. Patients with regional nodal recurrence, shorter RFI, and synchronous distant metastasis were associated with a poorer prognosis. HER2-positive disease had a higher rate of LRR events, more likely to have in-breast recurrence, and had an earlier relapse peak in the first 2 years after surgery.

CONCLUSIONS: LRR risk following BCS is generally low in Chinese ethnicity. Different recurrence patterns after BCS were related to distinct clinical outcomes. Management of LRR should be largely individualized and tailored to the extent of disease, the molecular profile of the recurrence, and to baseline clinical variables.

KEYWORDS: annual recurrence rate; breast-conserving surgery; loco-regional recurrence; molecular subtype; spatiotemporal recurrence pattern

PMID: 34527574

PMCID: PMC8435899

DOI: 10.3389/fonc.2021.690658