Garg Amit K, Strom Eric A, McNeese Marsha D, Buzdar Aman U, Hortobagyi Gabriel N, Kuerer Henry M, Perkins George H, Singletary S Eva, Hunt Kelly K, Sahin Asyegul, Schechter Naomi, Valero Vicente, Tucker Susan L, Buchholz Thomas A
Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Int J Radiat Oncol Biol Phys. 2004 May 1;59(1):138-45. doi: 10.1016/j.ijrobp.2003.10.037.
To help define the clinical and pathologic predictors of locoregional recurrence (LRR) in breast cancer patients treated with neoadjuvant chemotherapy and mastectomy without radiotherapy for early-stage disease.
We retrospectively reviewed the outcomes of all 132 patients with Stage I or II breast cancer treated in prospective institutional trials with neoadjuvant chemotherapy and mastectomy without radiotherapy between 1974 and 2001. The clinical stage (American Joint Committee on Cancer 1988) at diagnosis was I in 5%, IIA in 46%, and IIB in 49% of patients. The median age at diagnosis was 49 years. All patients were treated with either a doxorubicin-based neoadjuvant regimen or single-agent paclitaxel. The total LRR rates were calculated by the Kaplan-Meier method, and comparisons were made with two-sided log-rank tests. The median follow-up was 46 months.
The actuarial LRR rate at both 5 and 10 years was 10%. Factors that correlated positively with LRR included clinical Stage T3N0 (p = 0.0057), four or more positive lymph nodes at surgery (p = 0.0001), age < or =40 years at diagnosis (p = 0.0001), and no use of tamoxifen. In the patients who did not receive tamoxifen, estrogen receptor-positive disease correlated positively with LRR (p = 0.0067). The 5-year LRR rate for the 42 patients with clinical Stage T1 or T2 disease and one to three positive lymph nodes at surgery was 5% (only two events).
For patients with clinical Stage II breast cancer, T3 primary disease, four or more positive lymph nodes after chemotherapy, and age < or =40 years old predicted for LRR. For most patients with clinical T1 or T2 disease and one to three positive lymph nodes, the 5-year risk for LRR was low, and the routine inclusion of postmastectomy radiotherapy does not appear to be justified.
帮助确定接受新辅助化疗和保乳手术且未接受放疗的早期乳腺癌患者局部区域复发（LRR）的临床和病理预测因素。
我们回顾性分析了1974年至2001年间在一项前瞻性机构试验中接受新辅助化疗和保乳手术且未接受放疗的132例I期或II期乳腺癌患者的治疗结果。诊断时的临床分期（美国癌症联合委员会1988年标准）：5%的患者为I期，46%为IIA期，49%为IIB期。诊断时的中位年龄为49岁。所有患者均接受了以阿霉素为基础的新辅助化疗方案或单药紫杉醇治疗。总LRR率采用Kaplan-Meier法计算，并通过双侧对数秩检验进行比较。中位随访时间为46个月。
5年和10年的精算LRR率均为10%。与LRR呈正相关的因素包括临床分期T3N0（p = 0.0057）、手术时四个或更多阳性淋巴结（p = 0.0001）、诊断时年龄≤40岁（p = 0.0001）以及未使用他莫昔芬。在未接受他莫昔芬治疗的患者中，雌激素受体阳性疾病与LRR呈正相关（p = 0.0067）。42例临床分期为T1或T2且手术时有1至3个阳性淋巴结的患者的5年LRR率为5%（仅2例事件）。
对于临床II期乳腺癌患者，原发疾病为T3、化疗后四个或更多阳性淋巴结以及年龄≤40岁可预测LRR。对于大多数临床T1或T2且有1至3个阳性淋巴结的患者，5年LRR风险较低，保乳术后常规放疗似乎没有必要。
