Andre Fabrice, Slimane Khemaies, Bachelot Thomas, Dunant Arianne, Namer Moise, Barrelier Alain, Kabbaj Omar, Spano Jean Philippe, Marsiglia Hugo, Rouzier Roman, Delaloge Suzette, Spielmann Marc
Breast Cancer Unit, Comite 050, Institut Gustave Roussy, 39 Rue C Desmoulins, 94805 Villejuif, France.
J Clin Oncol. 2004 Aug 15;22(16):3302-8. doi: 10.1200/JCO.2004.08.095.
Although new drugs were approved during the 1990s for the treatment of metastatic breast cancer, it is not clear whether their use has changed the outcome of patients in daily practice. This study sought to determine whether survival has improved over time for breast cancer patients who had metastases at diagnosis.
A total of 724 patients have been treated in three French cancer centers for an initially metastatic breast cancer between 1987 and 2000; 343 were diagnosed between 1987 and 1993, and 381 were diagnosed between 1994 and 2000. Tumor characteristics, treatments, and outcomes of these patients were compared by chi(2) test, log-rank test, and Cox regression analysis.
Characteristics were not different between the patients diagnosed from 1987 to 1993 and those diagnosed from 1994 to 2000. Ten percent of patients treated from 1987 to 1994 and 58% of patients treated from 1994 to 2000 have received either a taxane or a new aromatase inhibitor. The 3-year overall survival rates were 27% for patients treated from 1987 to 1993 and 44% for patients treated from 1994 to 2000 (P <.001). The treatment period (1994 to 2000 v 1987 to 1993) was a prognostic factor in multivariate analysis (relative risk, 0.6; P <.001).
The survival of breast cancer patients presenting with metastases at diagnosis has improved over time. This study strongly suggests that this improvement is related to treatment.
尽管在20世纪90年代有新药被批准用于治疗转移性乳腺癌,但在日常临床实践中这些药物的使用是否改变了患者的预后尚不清楚。本研究旨在确定诊断时已有转移的乳腺癌患者的生存率是否随时间有所提高。
1987年至2000年间,共有724例患者在法国的三个癌症中心接受了初治转移性乳腺癌的治疗;其中343例在1987年至1993年间被诊断,381例在1994年至2000年间被诊断。通过卡方检验、对数秩检验和Cox回归分析比较了这些患者的肿瘤特征、治疗情况及预后。
1987年至1993年间诊断的患者与1994年至2000年间诊断的患者在特征上并无差异。1987年至1994年间接受治疗的患者中有10%,1994年至2000年间接受治疗的患者中有58%接受了紫杉烷类药物或新型芳香化酶抑制剂治疗。1987年至1993年间接受治疗的患者3年总生存率为27%,1994年至2000年间接受治疗的患者为44%(P<0.001)。在多因素分析中,治疗时期(1994年至2000年对比1987年至1993年)是一个预后因素(相对风险,0.6;P<0.001)。
诊断时已有转移的乳腺癌患者的生存率随时间有所提高。本研究强烈提示这种改善与治疗有关。