McCready D R, Chapman J A, Hanna W M, Kahn H J, Murray D, Fish E B, Trudeau M E, Andrulis I L, Lickley H L
Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
Ann Surg Oncol. 2000 Jul;7(6):416-26. doi: 10.1007/s10434-000-0416-z.
Invasive breast cancer is a frequently diagnosed disease that now comes with an ever expanding array of therapeutic management options. We assessed the effects of 20 prognostic factors in a multivariate context.
We accrued clinical data for 156 consecutive patients with stage 1-3 primary invasive breast cancer who were diagnosed in 1989-1990 at the Henrietta Banting Breast Center, and followed to 1995. There is complete follow-up for 91% of patients (median follow-up of 4.9 years). The event of interest was distant recurrence (for distant disease-free survival, DFS). We used Cox and log-normal step-wise regression to assess the multivariate effects of the following factors on DFS: age, tumor size, nodal status, histology, tumor and nuclear grade, lymphovascular and perineural invasion (LVPI), ductal carcinoma-in-situ (DCIS) type, DCIS extent, DCIS at edge of tumor, ER and PgR, ERICA, adjuvant systemic therapy, ki67, S-phase, DNA index, neu oncogene, and pRb.
There was strong evidence against the Cox assumption of proportional hazards for nodal status, and nodal status was not in the Cox step-wise model. With step-wise log-normal regression, a large tumor size (P < .001), positive nodes (P = .002), high nuclear grade (P = .01), presence of LVPI (P = .03), and infiltrating duct carcinoma not otherwise specified (P = .05) were associated with a reduction in DFS.
For nodal status, there was strong evidence against the Cox assumption of proportional hazards, and it was not included in the Cox model although it was in the log-normal model. Only traditional factors were included in the step-wise models. Thus, this statistical management of prognostic markers in breast cancer appears to be very important.
浸润性乳腺癌是一种常见的诊断疾病，目前其治疗管理选择日益增多。我们在多变量背景下评估了20个预后因素的影响。
我们收集了1989年至1990年在亨丽埃塔·班廷乳腺中心诊断的156例连续的1 - 3期原发性浸润性乳腺癌患者的临床数据，并随访至1995年。91%的患者有完整随访（中位随访时间为4.9年）。感兴趣的事件是远处复发（用于远处无病生存期，DFS）。我们使用Cox和对数正态逐步回归来评估以下因素对DFS的多变量影响：年龄、肿瘤大小、淋巴结状态、组织学、肿瘤和核分级、淋巴管和神经周围浸润（LVPI）、导管原位癌（DCIS）类型、DCIS范围、肿瘤边缘的DCIS、雌激素受体（ER）和孕激素受体（PgR）、ERICA、辅助全身治疗、ki67、S期、DNA指数、neu癌基因和视网膜母细胞瘤蛋白（pRb）。
有强有力的证据反对Cox模型中淋巴结状态的比例风险假设，且淋巴结状态未纳入Cox逐步模型。通过逐步对数正态回归分析，肿瘤体积大（P <.001）、淋巴结阳性（P =.002）、核分级高（P =.01）、存在LVPI（P =.03）以及未另行指定的浸润性导管癌（P =.05）与DFS降低相关。
对于淋巴结状态，有强有力的证据反对Cox模型的比例风险假设，尽管其在对数正态模型中，但未纳入Cox模型。逐步模型仅纳入了传统因素。因此，这种乳腺癌预后标志物的统计管理似乎非常重要。
