Elkhuizen P H, van Slooten H J, Clahsen P C, Hermans J, van de Velde C J, van den Broek L C, van de Vijver M J
Departments of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
J Clin Oncol. 2000 Mar;18(5):1075-83. doi: 10.1200/JCO.2000.18.5.1075.
Patients with invasive breast cancer may develop a local recurrence (LR) after breast-conserving therapy (BCT). Younger age has been found to be an independent risk factor for LR. Within a group of premenopausal node-negative breast cancer patients, we studied risk factors for LR and the effect of perioperative chemotherapy (PeCT) on LR.
The European Organization for Research and Treatment of Cancer (EORTC) conducted a randomized trial (EORTC 10854) to compare surgery followed by one course of PeCT (fluorouracil, doxorubicin, and cyclophosphamide) with surgery alone. From patients treated on this trial, we selected premenopausal patients with node-negative breast cancer who were treated with BCT to examine whether histologic characteristics and the expression of various proteins (estrogen receptor, progesterone receptor, p53, Ki-67, bcl-2, CD31, c-erbB-2/neu) are risk factors for subsequent LR. Also, the effect of one course of PeCT on the LR risk (LRR) was studied.
Using multivariate analysis, age younger than 43 years (relative risk [RR], 2.75; 95% confidence interval [CI], 1.46 to 5.18; P =.002), multifocal growth (RR, 3.34; 95% CI, 1.27 to 8.77; P =.014), and elevated levels of p53 (RR, 2. 14; 95% CI, 1.13 to 4.05; P =.02) were associated with higher LRR. Also, PeCT was found to reduce LRR by more than 50% (RR, 0.47; 95% CI, 0.25 to 0.86; P =.02). Patients younger than 43 years who received PeCT achieved similar LR rates as those of patients younger than 43 years who were treated with BCT alone.
In premenopausal node-negative patients, age younger than 43 years is the most important risk factor for LR after BCT; this risk is greatly reduced by one course of PeCT. The main reason for administering systemic adjuvant treatment is to improve overall survival. The important reduction of LR after BCT is an additional reason for considering systemic treatment in young node-negative patients with breast cancer.
浸润性乳腺癌患者在保乳治疗（BCT）后可能发生局部复发（LR）。已发现年轻是LR的独立危险因素。在一组绝经前淋巴结阴性乳腺癌患者中，我们研究了LR的危险因素以及围手术期化疗（PeCT）对LR的影响。
欧洲癌症研究与治疗组织（EORTC）进行了一项随机试验（EORTC 10854），比较手术加一个疗程的PeCT（氟尿嘧啶、阿霉素和环磷酰胺）与单纯手术。从该试验治疗的患者中，我们选择接受BCT治疗的绝经前淋巴结阴性乳腺癌患者，以检查组织学特征和各种蛋白质（雌激素受体、孕激素受体、p53、Ki-67、bcl-2、CD31、c-erbB-2/neu）的表达是否为后续LR的危险因素。此外，还研究了一个疗程的PeCT对LR风险（LRR）的影响。
多因素分析显示，年龄小于43岁（相对风险[RR]，2.75；95%置信区间[CI]，1.46至5.18；P = 0.002）、多灶性生长（RR，3.34；95%CI，1.27至8.77；P = 0.014）和p53水平升高（RR，2.14；95%CI，1.13至4.05；P = 0.02）与较高的LRR相关。此外，发现PeCT可使LRR降低超过50%（RR，0.47；95%CI，0.25至0.86；P = 0.0
