sechenovSechenov Medical JournalСеченовский вестник2218-73322658-3348Сеченовский Университет10.47093/2218-7332.2021.12.1.30-38sechenov-346Research ArticleONCOLOGYОНКОЛОГИЯLocal-free recurrence survival after breast-conserving surgery and the breast cancer complex treatmentБезрецидивная выживаемость после органосохраняющей хирургии и комплексного лечения рака молочной железыhttps://orcid.org/0000-0001-7141-2502ЗикиряходжаевА. Д.ZikiryahodjaevA. D.

Зикиряходжаев Азизжон Дильшодович, д-р мед. наук, заведующий отделением онкологии и реконструктивно-пластической хирургии молочной железы и кожи

ул. Погодинская, д. 6, г. Москва, 119121; ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Azizzhon D. Zikiryahodjaev, Dr of Sci. (Medicine), Head of the Department of Oncology and Reconstructive Plastic Surgery of the Breast and Skin

6, Pogodinskaya str., Moscow, 119121; 8/2, Trubetskaya str., Moscow, 119991

https://orcid.org/0000-0002-4178-9592ЕрмощенковаМ. В.ErmoshchenkovaM. V.

Ермощенкова Мария Владимировна, канд. мед. наук, заведующая I онкологическим отделением; доцент кафедры онкологии, радиотерапии и пластической хирургии

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991; ул. Бауманская, д. 17/1, г. Москва, 105005

+7 (926) 530-92-84

 

Maria V. Ermoshchenkova, Cand. of Sci. (Medicine), Head of the First Oncology Surgery Department

8/2, Trubetskaya str., Moscow, 119991; 17/1, Baumanskaya str., Moscow, 105005

+7 (926) 530-92-84

maryerm@mail.ruhttps://orcid.org/0000-0003-0993-8866БосиеваА. Р.BosievaA. R.

Босиева Алана Руслановна, аспирант отделения онкологии и реконструктивно-пластической хирургии молочной железы и кожи

ул. Погодинская, д. 6, г. Москва, 119121

Alana R. Bosieva, postgraduate student, Department of Oncology and Reconstructive Plastic Surgery of the Breast and Skin

6, Pogodinskaya str., Moscow, 119121

https://orcid.org/0000-0003-1824-6888ОмароваД. Ф.OmarovaJ. F.

Омарова Джанет Фридовна, аспирант кафедры онкологии, радиотерапии и пластической хирургии

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

 

Janet F. Omarova, postgraduate student, Department of Oncology, Radiotherapy and Plastic Surgery

8/2, Trubetskaya str., Moscow, 119991

https://orcid.org/0000-0003-0421-4172ВолченкоН. Н.VolchenkoN. N.

Волченко Надежда Николаевна, д-р мед. наук, профессор, заведующая отделом онкоморфологии

ул. Погодинская, д. 6, г. Москва, 119121

Nadezhda N. Volchenko, Dr. of Sci. (Medicine), Professor, Head of Oncomorphology Department

6, Pogodinskaya str., Moscow, 119121

https://orcid.org/0000-0002-0909-6278РешетовИ. В.ReshetovI. V.

Решетов Игорь Владимирович, д-р мед. наук, профессор, академик РАН, директор НОКЦ пластической хирургии, заведующий кафедрой онкологии, радиотерапии и пластической хирургии

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Igor V. Reshetov, Dr. of Sci. (Medicine), Professor, Academician of the RAS, Director of the Scientific and Educational Clinical Center for Plastic Surgery

8/2, Trubetskaya str., Moscow, 119991

 

Московский научный исследовательский онкологический институт им. П.А. Герцена – филиал ФГБУ «НМИЦ радиологии» Минздрава России; ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияP.A. Herzen Moscow Research Institute of Oncology – branch of the FSBI “NMITs radiology” of the Ministry of Health of Russia; Sechenov First Moscow State Medical University (Sechenov University)Russian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет); ГБУЗ «Городская клиническая онкологическая больница № 1» Департамента здравоохраненияРоссияSechenov First Moscow State Medical University (Sechenov University); The First Moscow Clinical Hospital of Oncology of the Moscow Department of Health CareRussian FederationМосковский научный исследовательский онкологический институт им. П.А. Герцена – филиал ФГБУ «НМИЦ радиологии» Минздрава РоссииРоссияP.A. Herzen Moscow Research Institute of Oncology – branch of the FSBI “NMITs radiology” of the Ministry of Health of RussiaRussian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation2021290420211213038Copyright © Zikiryahodjaev A.D., Ermoshchenkova M.V., Bosieva A.R., Omarova J.F., Volchenko N.N., Reshetov I.V., 20212021Зикиряходжаев А.Д., Ермощенкова М.В., Босиева А.Р., Омарова Д.Ф., Волченко Н.Н., Решетов И.В.Zikiryahodjaev A.D., Ermoshchenkova M.V., Bosieva A.R., Omarova J.F., Volchenko N.N., Reshetov I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sechenovmedj.com/jour/article/view/346Aim

Aim. To determine the frequency of local recurrence of breast cancer (BC) after performing breast-conserving surgery (BCS) during and after complex treatment, to study the risk factors for local recurrence and survival.

Materials and methods

Materials and methods. A retrospective cohort study of 675 patients with breast cancer who underwent BCS followed by remote radiotherapy was conducted. The frequency of local relapse and risk factors were studied, 3- and 5-year local-free survival. The odds ratios (OR) and 95% confidence intervals (CI) were calculated, and the Kaplan–Meyer curves were constructed.

Results

Results. Radical breast resections (RBR) were performed in 46.7% of patients, and oncoplastic breast resections (OBS) in 53.3% of patients. The most common histological type in both groups was invasive cancer with no signs of specificity: 76.9% and 84.1% – in the OBS and RBR groups, respectively. The incidence of cancer in situ was higher in the OBS group: 14.7% vs. 3.3% in the RBR group (p < 0.001), metastases in regional lymph nodes were more frequent in the RBR group: 34.3% against 20.3% in OBS (p < 0.001). According to the immunohistochemical type and degree of differentiation, the groups did not differ. For 3 years, the relapse-free survival rate was 99.7% in both groups, and for 5 years – 99.2% in the OBS group. and 99.7% in the RBR group, 6 years – 98.3% and 98.7%, respectively; no significant differences were found between the groups. There were no statistically significant differences in the frequency of relapses depending on the width of the resection edges from <1 to ≥10 mm. The risk of relapse was increased with a preserved menstrual status (OR 20.05; 95% CI 2.52–159.33), Her2/neu–positive (OR 5.11; 95% CI 1.04–25.09) and triple-negative types (OR 4.02; 95% CI 1.02–15.95), the degree of differentiation of G3 (OR 5.58; 95% CI 1.59–19.64).

Conclusion

Conclusion. BCS is characterized by oncological safety; the rate of local relapse within 6 years is 1.5%. Risk factors for relapse include active menstrual status, highly aggressive immunohistochemical types of breast cancer, and low degree of differentiation.

Цель

Цель. Определить частоту локальных рецидивов рака молочной железы (РМЖ) после выполнения органосохраняющих операций (ОСО) в процессе и после комплексного лечения, изучить факторы риска локального рецидива и выживаемость.

Материалы и методы

Материалы и методы. Проведено ретроспективное когортное исследование 675 пациенток с РМЖ, которым выполнены ОСО с последующей дистанционной лучевой терапией. Изучена частота локального рецидива и факторы риска, 3- и 5-летняя безрецидивная выживаемость. Рассчитаны: отношения шансов (ОШ) и 95% доверительные интервалы (ДИ), построены кривые Каплана – Мейера.

Результаты

Результаты. Радикальные резекции (РР) выполнены 46,7%, онкопластические резекции (ОПР) – 53,3% пациенток. Преимущественным гистологическим типом в обеих группах был инвазивный рак без признаков специфичности: 76,9 и 84,1% – в группах ОПР и РР соответственно. Частота рака in situ была выше в группе ОПР: 14,7% против 3,3% в группе РР (р < 0,001), метастазы в регионарных лимфатических узлах – чаще в группе РР: 34,3% против 20,3% в группе ОПР (р < 0,001). По иммуногистохимическому типу и степени дифференцировки группы не различались. В течение 3 лет безрецидивная выживаемость составила 99,7% в обеих группах, 5 лет – 99,2% в группе ОПР и 99,7% в группе РР, 6 лет – 98,3 и 98,7% соответственно; значимых различий между группами не установлено. По частоте рецидивов в зависимости от ширины краев резекции от <1 до ≥10 мм не установлено статистически значимых отличий. Риск рецидива был повышен при сохранном менструальном статусе (ОШ 20,05; 95% ДИ 2,52–159,33), Her2/ neu-позитивном (ОШ 5,11; 95% ДИ 1,04–25,09) и тройном негативном типах (ОШ 4,02; 95% ДИ 1,02–15,95), степени дифференцировки G3 (ОШ 5,58; 95% ДИ 1,59–19,64).

Заключение

Заключение. ОСО характеризуются онкологической безопасностью: частота развития локального рецидива в течение 6 лет – 1,5%. К факторам риска рецидива относятся: активный менструальный статус, высокоагрессивные иммуногистохимические типы РМЖ и низкая степень дифференцировки.

 

 

рак молочной железыорганосохраняющие операциирецидивыбезрецидивная выживаемостьонкопластическая резекцияbreast cancerbreast-conserving surgerycancer recurrencelocal-free recurrence survivaloncoplastic resectionReferencesGuidolin R., Lock M., Vogt R., et al. Recurrence and mortality after breast-conserving surgery without radiation. Curr Oncol. 2019; 26(6): 380–388. https://doi.org/10.3747/co.26.5225 PMID: 31896936Guidolin R., Lock M., Vogt R., et al. Recurrence and mortality after breast-conserving surgery without radiation. Curr Oncol. 2019; 26(6): 380–388. https://doi.org/10.3747/co.26.5225 PMID: 31896936Walstra C.J.E.F., Schipper R.J., Poodt I.G.M., et al. Repeat breast-conserving therapy for ipsilateral breast cancer recurrence: A systematic review. Eur J Surg Oncol. 2019; 45(8): 1317–1327. https://doi.org/10.1016/j.ejso.2019.02.008 PMID: 30795956Walstra C.J.E.F., Schipper R.J., Poodt I.G.M., et al. Repeat breast-conserving therapy for ipsilateral breast cancer recurrence: A systematic review. Eur J Surg Oncol. 2019; 45(8): 1317–1327. https://doi.org/10.1016/j.ejso.2019.02.008 PMID: 30795956Ozkaya Akagunduz O., Ergen A., Erpolat P., et al. Local recurrence outcomes after breast conserving surgery and adjuvant radiotherapy in ductal carcinoma in situ of the breast and a comparison with ECOG E5194 study. Breast; 2018; 42: 10–14. https://doi.org/10.1016/j.breast.2018.08.094 PMID: 30121548Ozkaya Akagunduz O., Ergen A., Erpolat P., et al. Local recurrence outcomes after breast conserving surgery and adjuvant radiotherapy in ductal carcinoma in situ of the breast and a comparison with ECOG E5194 study. Breast; 2018; 42: 10–14. https://doi.org/10.1016/j.breast.2018.08.094 PMID: 30121548Dahn H., Wilke D., Walsh G., et al. Radiation and/or endocrine therapy? Recurrence and survival outcomes in women over 70 with early breast cancer after breast-conserving surgery. Breast Cancer Res Treat. 2020; 182(2): 411–420. https://doi.org/10.1007/s10549-020-05691-6 PMID: 32441018Dahn H., Wilke D., Walsh G., et al. Radiation and/or endocrine therapy? Recurrence and survival outcomes in women over 70 with early breast cancer after breast-conserving surgery. Breast Cancer Res Treat. 2020; 182(2): 411–420. https://doi.org/10.1007/s10549-020-05691-6 PMID: 32441018Choi J., Laws A., Hu J., et al. Margins in breast-conserving surgery after neoadjuvant therapy. Ann Surg Oncol. 2018 Nov; 25(12): 3541–3547. https://doi.org/10.1245/s10434-018-6702-4 PMID: 30128902Choi J., Laws A., Hu J., et al. Margins in breast-conserving surgery after neoadjuvant therapy. Ann Surg Oncol. 2018 Nov; 25(12): 3541–3547. https://doi.org/10.1245/s10434-018-6702-4 PMID: 30128902Sellam Y., Shahadi I.D., Gelernter I., et al. Local recurrence of breast cancer: Salvage lumpectomy as an option for local treatment. Breast J. 2019 Jul; 25(4): 619–624. https://doi.org/10.1111/tbj.13290 PMID: 31087430Sellam Y., Shahadi I.D., Gelernter I., et al. Local recurrence of breast cancer: Salvage lumpectomy as an option for local treatment. Breast J. 2019 Jul; 25(4): 619–624. https://doi.org/10.1111/tbj.13290 PMID: 31087430Valachis A., Mamounas E.P., Mittendorf E.A., et al. Risk factors for locoregional disease recurrence after breast-conserving therapy in patients with breast cancer treated with neoadjuvant chemotherapy: An international collaboration and individual patient meta-analysis. Cancer. 2018 Jul 15; 124(14): 2923–2930. https://doi.org/10.1002/cncr.31518 PMID: 29723396Valachis A., Mamounas E.P., Mittendorf E.A., et al. Risk factors for locoregional disease recurrence after breast-conserving therapy in patients with breast cancer treated with neoadjuvant chemotherapy: An international collaboration and individual patient meta-analysis. Cancer. 2018 Jul 15; 124(14): 2923–2930. https://doi.org/10.1002/cncr.31518 PMID: 29723396Cambra M.J., Moreno F., Sanz X., et al. Role of boost radiotherapy for local control of pure ductal carcinoma in situ after breast-conserving surgery: a multicenter, retrospective study of 622 patients. Clin Transl Oncol. 2020 May; 22(5): 670–680. https://doi.org/10.1007/s12094-019-02168-x PMID: 31264148Cambra M.J., Moreno F., Sanz X., et al. Role of boost radiotherapy for local control of pure ductal carcinoma in situ after breast-conserving surgery: a multicenter, retrospective study of 622 patients. Clin Transl Oncol. 2020 May; 22(5): 670–680. https://doi.org/10.1007/s12094-019-02168-x PMID: 31264148Fitzal F., Filipits M., Fesl C., et al. PAM-50 predicts local recurrence after breast cancer surgery in postmenopausal patients with ER+/HER2-disease: results from 1204 patients in the randomized ABCSG-8 trial. Br J Surg. 2021 Apr 5; 108(3): 308–314. https://doi.org/10.1093/bjs/znaa089 PMID: 33608712Fitzal F., Filipits M., Fesl C., et al. PAM-50 predicts local recurrence after breast cancer surgery in postmenopausal patients with ER+/HER2-disease: results from 1204 patients in the randomized ABCSG-8 trial. Br J Surg. 2021 Apr 5; 108(3): 308–314. https://doi.org/10.1093/bjs/znaa089 PMID: 33608712Zumsteg Z.S., Morrow M., Arnold B., et al. Breast-conserving therapy achieves locoregional outcomes comparable to mastectomy in women with T1-2N0 triple-negative breast cancer. Ann Surg Oncol. 2013 Oct; 20(11): 3469–3476. https://doi.org/10.1245/s10434-013-3011-9 PMID: 23686101Zumsteg Z.S., Morrow M., Arnold B., et al. Breast-conserving therapy achieves locoregional outcomes comparable to mastectomy in women with T1-2N0 triple-negative breast cancer. Ann Surg Oncol. 2013 Oct; 20(11): 3469–3476. https://doi.org/10.1245/s10434-013-3011-9 PMID: 23686101Smanykó V., Mészáros N., Újhelyi M., et al. Second breastconserving surgery and interstitial brachytherapy vs. salvage mastectomy for the treatment of local recurrences: 5-year results. Brachytherapy. 2019 May-Jun; 18(3): 411–419. https://doi.org/10.1016/j.brachy.2019.02.004 PMID: 30890318Smanykó V., Mészáros N., Újhelyi M., et al. Second breastconserving surgery and interstitial brachytherapy vs. salvage mastectomy for the treatment of local recurrences: 5-year results. Brachytherapy. 2019 May-Jun; 18(3): 411–419. https://doi.org/10.1016/j.brachy.2019.02.004 PMID: 30890318Tan P.H., Ellis I., Allison K., et al. The 2019 World Health Organization classification of tumours of the breast. Histopathology. 2020 Aug; 77(2): 181–185. https://doi.org/10.1111/his.14091 PMID: 32056259Tan P.H., Ellis I., Allison K., et al. The 2019 World Health Organization classification of tumours of the breast. Histopathology. 2020 Aug; 77(2): 181–185. https://doi.org/10.1111/his.14091 PMID: 32056259Park S., Ahn S.D., Choi E.K., Kim S.S. The effect of escalating the boost dose for patients with involved resection margin after breast-conserving surgery. Jpn J Clin Oncol. 2018 Mar; 48(3): 272–277. https://doi.org/10.1093/jjco/hyy002 PMID: 29385496Park S., Ahn S.D., Choi E.K., Kim S.S. The effect of escalating the boost dose for patients with involved resection margin after breast-conserving surgery. Jpn J Clin Oncol. 2018 Mar; 48(3): 272–277. https://doi.org/10.1093/jjco/hyy002 PMID: 29385496Senkus E., Kyriakides S., Ohno S., et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015 Sep; 26(5): v8–30. https://doi.org/10.1093/annonc/mdv298 PMID: 26314782Senkus E., Kyriakides S., Ohno S., et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015 Sep; 26(5): v8–30. https://doi.org/10.1093/annonc/mdv298 PMID: 26314782Houssami N., Macaskill P., Marinovich M.L., Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014 Mar; 21(3): 717–730. https://doi.org/10.1245/s10434-014-3480-5 PMID: 24473640Houssami N., Macaskill P., Marinovich M.L., Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014 Mar; 21(3): 717–730. https://doi.org/10.1245/s10434-014-3480-5 PMID: 24473640Amin M.B., Greene F.L., Edge S.B., et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017 Mar; 67(2): 93–99. https://doi.org/10.3322/caac.21388 PMID: 28094848Amin M.B., Greene F.L., Edge S.B., et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017 Mar; 67(2): 93–99. https://doi.org/10.3322/caac.21388 PMID: 28094848Yiannakopoulou E.C., Mathelin C. Oncoplastic breast conserving surgery and oncological outcome: Systematic review. Eur J Surg Oncol. 2016 May; 42(5): 625–630. https://doi.org/10.1016/j.ejso.2016.02.002 PMID: 26922045Yiannakopoulou E.C., Mathelin C. Oncoplastic breast conserving surgery and oncological outcome: Systematic review. Eur J Surg Oncol. 2016 May; 42(5): 625–630. https://doi.org/10.1016/j.ejso.2016.02.002 PMID: 26922045De La Cruz L., Blankenship S.A., Chatterjee A., et al. Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: A systematic literature review. Ann Surg Oncol. 2016 Oct; 23(10): 3247–3258. https://doi.org/10.1245/s10434-016-5313-1 PMID: 27357177De La Cruz L., Blankenship S.A., Chatterjee A., et al. Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: A systematic literature review. Ann Surg Oncol. 2016 Oct; 23(10): 3247–3258. https://doi.org/10.1245/s10434-016-5313-1 PMID: 27357177Guidolin K., Lock M., Vogt K., et al. Recurrence and mortality after breast-conserving surgery without radiation. Curr Oncol. 2019 Dec; 26(6): 380–388. https://doi.org/10.3747/co.26.5225 PMID: 31896936Guidolin K., Lock M., Vogt K., et al. Recurrence and mortality after breast-conserving surgery without radiation. Curr Oncol. 2019 Dec; 26(6): 380–388. https://doi.org/10.3747/co.26.5225 PMID: 31896936

The authors declare that there are no conflicts of interest present.