乳腺叶状肿瘤术后局部复发的预后因素分析

目的探讨乳腺叶状肿瘤术后局部复发的预后因素。方法回顾性分析2011年1月至2019年12月于北京大学人民医院乳腺中心接受手术切除并经术后病理学检查证实的276例乳腺叶状肿瘤患者的临床资料,记录临床病理学资料。入组患者均为女性,年龄(41.5±11.3)岁(范围:11~76岁),肿瘤最大径为35(28)mm[M(Q_R)]。276例患者均接受开放手术,包括乳房全切除术17例,肿物切除术259例。随访截至2020年9月30日。采用Kaplan-Meier法计算各类叶状肿瘤的累积无局部复发生存率,采用Log-rank检验进行组间比较,采用Cox比例风险模型分析局部复发的预后因素。结果术后病理学检查证实良性叶状肿瘤191例,交界性67例,恶性18例。249例患者获得>6个月的随访,局部复发率为14.1%(35/249),复发间期为(28.6±22.2)个月(范围:2~96个月),良性、交界性、恶性叶状肿瘤分别为(29.1±18.1)个月(范围:2~80个月)、(32.1±30.1)个月(范围:5~96个月)、(12.0±6.9)个月(范围:8~20个月)。肿瘤最大径(≥100 mm比<50 mm,HR=3.968,95%CI:1.550~10.158,P=0.004)、肉瘤类异质性分化(有比无,HR=26.933,95%CI:3.105~233.600,P=0.003)是局部复发的独立预后因素。恶性叶状肿瘤远处转移导致死亡1例,良性、交界性、恶性叶状肿瘤的3年无局部复发生存率分别为88.2%、81.7%、81.4%(P=0.300)。结论叶状肿瘤有一定的局部复发率,肿瘤最大径、肉瘤类异质性分化可能与叶状肿瘤的局部复发相关。     

Factors associated with local breast cancer recurrence after lumpectomy alone

Background: The purpose was to determine the rate of local breast relapse in patients with breast cancer uniformly treated with partial mastectomy but without postoperative radiotherapy and without systemic adjuvant therapy. We also systematically examined the factors associated with local recurrence to determine whether a low-risk subgroup existed. Methods: A retrospective review of a prospectively followed (median, 8 years) cohort of 293 patients was performed. The end-point was ipsilateral local breast cancer recurrence. The patient's age, tumor size, nodal status, estrogen and progesterone receptor status, histology, and tumor and nuclear grade were studied, as were the presence and amount of carcinoma in situ and the presence of tumor emboli using univariate Kaplan-Meier and Cox step-wise multivariate analyses. Results: The overall local relapse rate was 26% (77 recurrences). Univariate factors significantly associated with decreased local relapse included older age, negative nodes, small tumor size, positive estrogen receptor status, and absence of tumor emboli. Significant multivariate variables were age, nodal status, estrogen receptor status, absence of comedo carcinoma in situ, and tumor emboli. A low-risk subgroup of 66 patients was defined with a 6% 10-year local recurrence rate. Conclusion: Important patient and tumor variables associated with local breast cancer relapse after breast-conserving surgery can define a low-risk subgroup.     

良性与交界性叶状肿瘤局部复发风险的分析

目的探讨良性和交界性乳腺叶状肿瘤的复发率以及手术切缘宽度与复发风险的关系。方法回顾性性分析2008年1月至2015年12月在我院行手术切除的良性及交界性叶状肿瘤的患者。收集的数据包括:年龄、原发肿瘤大小、组织分级、手术方式和局部复发情况。结果共入组118名患者,其中为良性81例,交界性37例。患者平均年龄为48.3岁,肿瘤平均大小为4.6cm,平均随访时间3.5年,共有18例患者出现复发,其中良性肿瘤的复发率为13.5%,交界性肿瘤复发率为18%,但缺少足够的数据说明手术切缘多少最合适。结论交界性比良性叶状肿瘤复发率高,但乳腺肿物广泛切除并不能预防非恶性乳腺叶状肿瘤的复发。     

直肠癌根治术后盆腔局部复发的外科防治策略

直肠癌根治术后肿瘤复发者中，有30％～50％的患者只出现单独的盆腔脏器衰竭；盆腔局部复发为直肠癌根治术后5年内死亡的主要原因。一旦复发肿瘤不能切除，患者只能接受结肠造瘘、化疗等姑息性治疗，疼痛、出血、肠瘘、尿瘘、肠道尿道梗阻等症状常使患者痛不欲生。因此，直肠癌术后盆腔内局部复发是肿瘤治疗领域最有挑战性的难题之一，通过良好的局部控制有望提高患者的生存率。     

Low local recurrence rates in young Asian patients with phyllodes tumours: less is more

Background: Phyllodes tumours are increasingly being discovered incidentally in young patients after excision of a seemingly innocuous breast lump. The clinical course of this group of patients has not been well‐described, especially in the Asian population. Methods: A retrospective review of 44 consecutive patients below 25 years of age undergoing surgery for phyllodes tumours at our institution from 1992 to 2010 was conducted. Clinico‐pathological data, local recurrence rates and margin involvement were recorded. Results: The majority of the patients had benign lesions treated with simple enucleation, and there were no local recurrences documented after a mean and median length of follow‐up of 47.6 and 29.5 months, respectively. Conclusion: We conclude that in young Asian patients who present with benign phyllodes tumours, simple excision, followed by close follow‐up is sufficient, regardless of surgical margin status.     

Factors influencing local recurrence after abdominoperineal resection for cancer of the rectum and rectosigmoid.

One hundred and fifty-two patients who underwent abdominoperineal resection for cancer of the rectum and rectosigmoid are reviewed. Six physicians were selected to predict which of these patients would have a local recurrence. All information available at the end of the operation was duplicated and submitted to the observers. None of the physicians was able to predict local recurrence significantly better than random. There were 31 local recurrences, i.e. an incidence of 20-4 per cent. Low level of tumour in the rectum, local spread into perirectal fat or serosa, lymph node involvement and age below 60 years at time of operation were the only factors that were statistically related to local recurrence. The strategy for careful follow-up of patients at risk is outlined and a plea is made for a controlled trial of postoperative radiotherapy.     

Factors influencing local recurrence after excision and radiotherapy for primary breast cancer

Between November 1979 and December 1986, 263 patients were treated for primary breast cancer by local excision and radiotherapy at the City Hospital, Nottingham. Local recurrence within the treated breast occurred in 56 patients (21 per cent), in 18 (6.8 per cent) of whom it was gross and uncontrollable. An analysis of clinicopathological features shows patient age, nodal status, tumour size, presence of definitive vascular invasion, adjacent ductal carcinoma in situ and grade to be predictive of local recurrence. A Cox's multivariate analysis of these factors shows the first four to be independently significant. The factors can be combined as a prognostic index which allows identification of patients at high risk of local recurrence. On the basis of these findings we have altered our selection policy for patients suitable for breast conservation.     

Two cases of osteochondroma recurrence after surgical resection

Osteochondromas are the most common bone tumor found in children. A review of 114 resected osteochondromas over a 10-year period revealed recurrence in 2 cases. The overall recurrence rate of these lesions is less than 2% and was found to be 1.8% in this review.     

胃癌术后复发及影响因素的探讨

目的探讨胃癌术后复发及影响因素,为改善个体化综合治疗提供依据。方法回顾性分析中山市博爱医院普外2005-08—2010-09胃癌根治术后复发者160例资料,采用Logistic回归分析对可能影响术后复发的15项临床、病理和治疗措施进行分析。结果 160例平均复发时间为术后21.1个月,2 a内复发率74.4%,2～5 a内复发率21.9%,5 a后复发率3.8%。区域局部复发占17.5%,腹膜和远处淋巴结转移复发占63.1%,血源性转移复发占19.4%。其中单一复发占80.6%,多种复发类型占19.4%。logistic多因素回归分析显示病程分期、TNM分期、术后腹腔化疗、术前介入化疗是影响术后复发死亡的独立因素,其中腹腔化疗、介入化疗是保护因素。结论胃癌根治术后复发大部分发生在术后2 a内,以腹膜复发常见,影响术后复发的原因由多方面促成,独立因素起主要作用。     

胃肠癌术后复发的外科治疗

胃肠道恶性肿瘤临床主要以胃癌和结直肠癌为主。对于胃癌和肠癌患者来说，影响其预后的主要因素就是肿瘤复发问题。胃癌和结直肠癌同属消化道肿瘤，但术后癌复发的形式却明显不同。胃癌腹膜转移占40％～50％，肝转移占10％～15％；而结直肠癌则相反，肝转移占50％左右；两者预后也不一样，胃癌肝转移预后较差，结直肠癌的肝转移则发展较慢。因此，我们将两者分别加以讨论。     

The nature of local recurrence after colorectal cancer resection

Objective Local recurrence (LR) after rectal cancer resection has long been regarded as a particular problem, its incidence having been high. This study aims to determine the reasons why. Method A prospective record was kept of all 887 cases of colorectal adenocarcinoma referred to one surgeon between 1989 and 2000. Of these, 802 underwent major resection. They were followed up for 5 years or until death. Results There was no significant difference between LR rates throughout the colorectum (P = 0.74). LR was significantly related to tumour grade (P < 0.001) and to tumour stage (P < 0.001), but not to the need to resect involved adjacent structures (P = 0.08), nor, after restorative rectal resection, to the distal margin of clearance (P = 0.97). A difference became apparent between recurrence resulting from tumour left in or implanted into the operation field and tumour resulting from pre‐excision metastasis, here called, respectively, technique‐related (TLR) and pre‐excision metastatic (MLR) local recurrence. MLR was significantly related to tumour stage (P < 0.001), while TLR was not. Some TLR can be curatively excised. Conclusion Rectal LR is no more common than colonic LR. There may be practical merit in discriminating between TLR and MLR.     

Factors associated with local breast cancer recurrence after lumpectomy alone: Postmenopausal patients

Background: We have been following a cohort of patients who underwent a lumpectomy without receiving adjuvant radiotherapy or adjuvant systemic therapy. We now report the experience of a postmenopausal subgroup. Methods: The postmenopausal subgroup included 244 patients accrued between 1977 and 1986 and followed up. The end point was ipsilateral local breast cancer recurrence. The factors studied were the patient’s age in years; tumor size (in mm); nodal status (N-, Nx, N+); estrogen and progesterone receptor status (<10, ≥10 fmol/mg protein); presence or absence of lymphovascular/perineural invasion; presence or absence, and type, of DCIS (none, non-comedo, comedo); percentage of DCIS; histological grade (1,2,3); and nuclear grade (1,2,3). Univariate analyses consisted of Kaplan-Meier plots and the Wilcoxon (Peto-Prentice) test statistic; the multivariate analyses were step-wise Cox and log-normal regressions. Results: The median follow-up of those patients still alive was 9.1 years, and the overall relapse rate was 24% (59/244). The univariate results indicated that the characteristics of smaller tumor size, negative nodes, positive ER status, and no lymphovascular or perineural invasion were associated with significantly (P<.05) lower relapse. From the multivariate analyses, the factors lymphovascular or perineural invasion, age, and amount of DCIS were all significantly associated with local relapse with both Cox and log-normal regressions. Additionally, there was weak evidence of an association between ER (P=.08 in the Cox regression and in the log-normal) and nodal status (P=.09 in the log-normal regression) with local relapse. We also are able to define a low-risk subgroup (N-, age ≥65, no comedo, ER positive, no emboli) with a crude 10-year local recurrence rate of 9%. Conclusion: With longer follow-up, and for postmenopausal patients, there continues to be support for the theory that local relapse is affected by the factors lymphovascular or perineural invasion, age, amount of DCIS, ER, and nodal status. A low risk subgroup has been identified. Presented at the 53rd Annual Meeting of the Society of Surgical Oncology, March 16–19, 2000, New Orleans.     

大肠癌切除吻合术后局部复发因素分析

本文对４０例大肠癌切除吻合术后局部复发的因素进行了统计学分析。应用Ｃｏｘ回归分析的方法，建立了大肠癌术后复发因素的Ｃｏｘ模型，并拽出各个因素影响肿瘤复发的强度（相对危险度）。认为，肿瘤本身生物学行为，诸如部位、肿瘤大小、细胞分化程度、淋巴结转移情况仍是促进复发的主要因素，相对危险度很高（Ｐ＜０．０５），证实了非肿瘤因素在复发上亦起着很重要的作用。如病人肥胖，肿瘤所在直肠上位置低下等可致手术操作困难     

Phyllodes tumours of the breast: Outcomes and recurrence after excision

IntroductionWide excision margins are traditionally recommended for phyllodes tumours of the breast to reduce recurrence. Recent studies suggest margin status and histopathological features, excluding margin width, influence recurrence. This study evaluated treatment outcomes for phyllodes tumours and examined predictors of recurrence.MethodsClinical and follow-up information for phyllodes tumours patients treated between 2008 and 2017 were obtained from chart review. Tumour subtype and histopathological features were determined from pathology reports. Primary endpoints were recurrence rate and time to recurrence or mortality.ResultsAmong 96 patients, there were 6 local and 1 distant recurrences. Overall recurrence rate was 7.3% and average time-to-recurrence was 13.7 months. Tumour size, margin status, necrosis, and mitoses were associated with recurrence; margin width was not. Two deaths (2.1%) from malignant phyllodes occurred.ConclusionsMultiple histopathological features influence phyllodes recurrence. Wide excision and re-excising positive margins for benign tumours was not beneficial.     

Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer

OBJECTIVE: To examine the incidence of local recurrence (LR) and factors associated with it in a population of patients who underwent skin-sparing mastectomy (SSM) and immediate reconstruction for invasive carcinoma. SUMMARY BACKGROUND DATA: The efficacy of SSM has been challenged by concerns about increased risks of LR. METHODS: A consecutive series of 173 patients (176 cancers) with invasive carcinoma underwent SSM and immediate breast reconstruction (June 1986 to December 1997). Data were analyzed by the Kaplan-Meier method, the log-rank statistic test, and the Cox proportional hazards model. RESULTS: Mean patient age was 47 +/- 9 years (27% were 40 or younger). The AJCC stages were 1 = 43%, 2 = 52%, and 3 = 5%. Thirty percent of tumors were poorly differentiated. With a median follow-up of 73 months, the LR rate was 4.5%. The mean local relapse-free interval was 26 months. Seventy-five percent of patients who presented with LR developed distant metastases and died of disease within a mean of 21 months. On univariate analysis, factors associated with higher LR rate were tumor stage 2 or 3, tumor size larger than 2 cm, node-positive disease, and poor tumor differentiation. Actuarial 1-, 3-, and 5-year overall survival rates were 98%, 94%, and 88%, respectively. On multivariate analysis, factors associated with decreased survival were advanced stage, presence of LR, and absence of hormone therapy. LR was a highly significant predictor of tumor-related death. CONCLUSIONS: There is a low incidence of LR after SSM, and it is associated with advanced disease at presentation. LR is an independent risk factor for tumor-related death.     

经骶尾、腹腔联合切除治疗直肠癌前切除术后局部复发

目的探讨直肠癌前切除术后局部复发病例的再手术治疗成绩并其临床意义。方法对1999年1月至2004年1月间43例直肠癌前切除术后局部复发再手术病例的临床资料进行回顾性分析。结果手术采用折刀体位,经骶尾、腹腔联合切除术式,43例中27例行根治性切除术,16例行姑息性切除术,根治性切除组的术后3年、5年生存率分别为59.3%、48.1%,明显高于姑息性切除组的25%、18.8%（P〈0.05）。结论经骶尾、腹腔施行直肠癌前切除术是治疗直肠癌切除术后肿瘤局部复发的有效方法。     

The prediction of local or regional recurrence after simple mastectomy for operable breast cancer

Both the histological grade of the primary tumour and lymph node status have been found to contribute significantly towards the development of a local or regional recurrence after simple mastectomy for operable breast cancer. No other factor, from a series of seven studied, has been found to be of independent significance. A small group of patients with grade III tumours, lymph node positive at mastectomy, has been identified in whom more than 40 per cent of all symptomatic local or regional recurrences occurred. The chance a patient in this group has of developing a local or regional recurrence requiring treatment within 4 years approaches 50 per cent.