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Geburtshilfe Frauenheilkd 2001; 61(2): 63-69
DOI: 10.1055/s-2001-11161
Originalarbeit

Georg Thieme Verlag Stuttgart · New York

Prognose des Lokalrezidives beim nodalnegativen Mammakarzinom in Abhängigkeit von der Primäroperation - Langzeitergebnisse einer Matched-Pair-Analyse[*]

Prognosis of Locally Recurrent Node-Negative Breast Cancer According to Type of Primary Surgery - Long-term Results of a Matched Pair AnalysisW. Janni1 , Th. Dimpfl1 , D. Rjosk1 , B. Strobl1 , F. Bergauer1 , H. Sommer1 , B. Lampe2 , Th. Genz3
  • 1 I. Frauenklinik, Klinikum der Ludwig-Maximilians-Universität München
  • 2 Klinikum Leverkusen, Abteilung für Gynäkologie und Geburtshilfe
  • 3 Kreiskrankenhaus Garmisch-Partenkirchen
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Publication History

Publication Date:
31 December 2001 (online)

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Zusammenfassung

Dem Lokalrezidiv nach Mastektomie wird häufig eine schlechtere Prognose zugeschrieben, als dem Lokalrezidiv nach brusterhaltender Therapie bei Mammakarzinom. Es bleibt jedoch unklar, ob dies durch eine Ungleichverteilung der Prognosefaktoren zum Zeitpunkt der Primärtherapie oder durch eine unterschiedliche tumorbiologische Dynamik der Rezidivierung verursacht wird.

Fragestellung

Lässt sich im Langzeitverlauf auch bei Patientinnen mit der primär guten Prognose eines pT1 - 2N0 Mammakarzinoms ein Unterschied im Überleben nach dem Lokalrezidiv nach Mastektomie vs. BET nachweisen?

Methode

Matched-Pair-Analyse von 62 nodalnegativen Patientinnen, die nach primärer R0-Resektion eines pT1 - 2 Mammakarzinoms ein Lokalrezidiv ohne Anhalt für Fernmetastasierung erlitten. Die Paarbildung erfolgte nach größtmöglicher Übereinstimmung in Tumorgröße, Tumorgrading und Alter. Durch uni- und multivariate Analyse wurde die Bedeutung verschiedener Einflussfaktoren auf das Überleben nach dem Rezidiv geprüft. Die mittlere Nachbeobachtungszeit betrug 7,5 Jahre.

Ergebnisse

Die Patientenkollektive wiesen keine Unterschiede in Bezug auf die Prognosefaktoren primäre Tumorgröße (p = 1,00) und histopathologisches Grading (p = 0,60) und in Bezug auf die Größe der Rezidivtumoren (p = 0,63) auf. Das Lokalrezidiv trat bei Patientinnen nach Mastektomie im Schnitt 8 Monate früher auf als bei Patientinnen nach BET (p = 0,35). Patientinnen in der Mastektomiegruppe wiesen ein geringeres Überleben nach dem Rezidiv auf (98 Monate), als Patientinnen in der BET-Gruppe (205 Monate). Dieser Unterschied erreicht jedoch kein statistisch signifikantes Niveau (p = 0,11). Sowohl in der univariaten wie in der multivariaten Analyse zeigte sich die Länge des rezidivfreien Intervalls als einziger unabhängiger prognostischer Einflussfaktor auf das Überleben nach dem Rezidiv (univariat: p = 0,015; multivariat: p = 0,0011), jedoch nicht der primäre Operationsmodus.

Schlussfolgerung

Die schlechtere Überlebensprognose von Patientinnen (n = 62) mit einem Lokalrezidiv nach Mastektomie wegen eines nodalnegativen Mammakarzinoms scheint vor allem mit dem durchschnittlich kürzeren rezidivfreien Intervall dieser Patientinnen assoziiert zu sein.

Summary

Objective

Most studies have found survival after local recurrence of breast cancer to be poorer after mastectomy than after breast-conserving surgery. We studied whether this is the case because patients undergoing mastectomy have a more unfavorable risk profile and whether it applies also to patients with early stage disease.

Methods

We conducted a matched-pair analysis (breast-conserving surgery vs. mastectomy) of 62 patients with local recurrence of early stage (pT1 - pT2 N0) breast cancer without evidence of systemic disease. Patients were matched for tumor size, histologic grade and age. Prognostic parameters at the time of primary diagnosis and at recurrence were evaluated with univariate and multivariate analyses with respect to survival after recurrence. The median follow-up was 7.5 years.

Results

There were no significant differences between the two groups in the size of the primary tumor, histologic grading, and size of recurrent tumor. The disease-free interval between primary diagnosis and local recurrence was 8 months shorter in patients after mastectomy than in those after breast-sparing surgery (p = 0.35). Survival after recurrence was shorter in the patients after mastectomy but this difference was not statistically significant (98 vs. 208 months, respectively; p = 0.11). The disease-free interval before local recurrence (but not the type of primary surgery) was the only independent prognostic factor for subsequent survival in both the univariate (p = 0.02) and the multivariate (p = 0.01) analyses.

Conclusion

The difference in survival after local recurrence after mastectomy compared with breast-sparing surgery for early breast cancer is small and appears to be associated with different disease-free intervals before local recurrence.

Schlüsselwörter

Mammakarzinom - Gesamtüberleben - Prognose - Metastasen - Lokalrezidiv

Key words

Breast neoplasm - Overall survival - Neoplasm metastasis - Neoplasm recurrence - Prognosis

1 Gefördert von der Friedrich-Baur-Stiftung der LMU München.

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1 Gefördert von der Friedrich-Baur-Stiftung der LMU München.

Dr. med. Wolfgang Janni

I. Frauenklinik

Maistraße 11

80337 München

Email: E-mail: janni@fk-i.med.uni-muenchen.de