Pierga J Y, Asselain B, Jouve M, Diéras V, Carton M, Laurence V, Girre V, Beuzeboc P, Palangié T, Dorval T, Pouillart P
Medical Oncology Department, Institut Curie, Paris Cedex 05, France.
Cancer. 2001 Mar 15;91(6):1079-89. doi: 10.1002/1097-0142(20010315)91:6<1079::aid-cncr1103>3.0.co;2-s.
The objective of the current study was to analyze the impact of adjuvant chemotherapy in comparison with other prognostic parameters on the outcome of a series of patients with breast carcinoma at time of metastatic recurrence.
Data from 1430 patients accrued in 8 prospective trials of anthracycline-based first-line chemotherapy conducted at the Institut Curie between 1977 and 1992 were reviewed.
Patients who had not received adjuvant chemotherapy had better response rates (66%) than pretreated patients (56%; P < 0.0001). Median overall survival rates after metastatic recurrence were 26 months compared with 19 months, respectively (P < 0.0001). Local and regional recurrences as well as the number of organ sites involved with metastatic disease were reduced in patients who had received adjuvant chemotherapy. In a multivariate analysis, the following parameters if present at the initiation of treatment were associated with poor outcome: elevated lactico dehydrogenase (LDH), low Karnofsky index, short disease free interval, more than two involved sites, liver involvement, and prior adjuvant chemotherapy. This adverse prognostic effect of prior adjuvant chemotherapy was independent of the type of drugs and of the duration of the treatment and was present even in the subgroup patients with prolonged disease free intervals longer than 48 months.
Adjuvant chemotherapy adversely affects overall response rates and overall survival rates in patients with metastatic breast carcinoma treated with first-line anthracycline based chemotherapy.
本研究的目的是分析辅助化疗与其他预后参数相比，对一系列乳腺癌患者转移复发时预后的影响。
回顾了1977年至1992年在居里研究所进行的8项基于蒽环类药物的一线化疗前瞻性试验中纳入的1430例患者的数据。
未接受辅助化疗的患者缓解率（66%）高于接受过预处理的患者（56%；P<0.0001）。转移复发后的中位总生存率分别为26个月和19个月（P<0.0001）。接受辅助化疗的患者局部和区域复发以及发生转移疾病的器官部位数量减少。在多变量分析中，治疗开始时存在以下参数与预后不良相关：乳酸脱氢酶（LDH）升高、卡诺夫斯基指数低、无病间期短、超过两个受累部位、肝脏受累以及既往辅助化疗。既往辅助化疗的这种不良预后影响与药物类型和治疗持续时间无关，甚至在无病间期延长超过48个月的亚组患者中也存在。
辅助化疗对接受基于蒽环类药物的一线化疗的转移性乳腺癌患者的总缓解率和总生存率有不利影响。
