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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Loco-regional recurrence after mastectomy in high-risk breast cancer-risk and prognosis. An analysis of patients from the DBCG 82 b&c randomization trials.
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Loco-regional recurrence after mastectomy in high-risk breast cancer-risk and prognosis. An analysis of patients from the DBCG 82 b&c randomization trials.

机译：乳房切除术后局部区域复发的高危乳腺癌的风险和预后。对来自DBCG 82 b＆c随机试验的患者的分析。

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BACKGROUND AND PURPOSE: In the DBCG 82 b&c trials, 3083 patients with stages II and III breast cancer were randomised to receive post-mastectomy radiotherapy (RT) versus no RT in addition to systemic therapy. The study showed a decrease in loco-regional recurrences and an improved survival in patients receiving RT. The aim of the present study was to identify risk factors for loco-regional recurrence (LRR), to evaluate the treatment of LRR and to examine the prognosis after LRR. PATIENTS AND METHODS: The 18-year probabilities of LRR were calculated for different prognostic factors using the Kaplan-Meier method. The efficacy of different LRR treatments was compared. The 5-year survival and distant metastases (DM) probability after LRR was calculated with regard to initial randomization group, primary tumor and recurrence related variables. RESULTS: Of the 3083 patients, 535 had a LRR alone as first site of failure. In univariate analyses, large primary tumor size, ductal carcinoma, high malignancy grade, fascia invasion, few removed nodes, many positive nodes and extracapsular invasion were all risk factors for developing LRR. Combined treatment with surgery and RT at the time of LRR increased the persistent loco-regional control. The 5-year probability of subsequent DM was 73% irrespective of initial randomization group. In multivariate analysis, large primary tumor size, many positive nodes, extracapsular invasion, supra/infraclaviculary failures, multiple LRR and a short interval less than 2 years to first LRR were poor prognostic factors for survival. CONCLUSIONS: Twenty-seven percent of LRR patients had no DM 5 years after failure. Initial randomization group did not alter the prognosis after LRR. Combined treatment of the LRR with surgery and RT improved persistent loco-regional control compared with surgery or RT alone.
机译：背景与目的：在DBCG 82 b＆c试验中，将3083例II期和III期乳腺癌患者随机分配接受乳房切除术后放疗（RT）以及除全身治疗外不接受RT。该研究显示接受RT的患者局部区域复发减少，生存率提高。本研究的目的是确定局部区域复发（LRR）的危险因素，评估LRR的治疗并检查LRR后的预后。患者和方法：采用Kaplan-Meier方法计算不同预后因素的LRR 18年概率。比较了不同LRR治疗的疗效。对于初始随机分组，原发肿瘤和复发相关变量，计算了LRR后5年生存和远处转移（DM）的可能性。结果：在3083名患者中，有535名仅将LRR作为失败的第一部位。在单因素分析中，原发肿瘤大，导管癌，恶性程度高，筋膜浸润，切除的淋巴结少，阳性淋巴结多和囊外侵袭都是发生LRR的危险因素。 LRR时结合手术和RT进行联合治疗可增强对局部区域的持续控制。与最初的随机分组无关，其后发生DM的5年可能性为73％。在多变量分析中，原发肿瘤大，许多阳性淋巴结，囊外浸润，锁骨上/锁骨上失败，多次LRR以及距首次LRR不到2年的短暂间隔是不良的生存预后因素。结论：LRR患者中有百分之二十七在失败后五年没有DM。最初的随机分组未改变LRR后的预后。与单纯手术或放疗相比，LRR与手术和放疗的联合治疗改善了持续的局部区域控制。

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