在五项美国国立外科辅助乳腺和肠道项目的淋巴结阳性辅助性乳腺癌试验中，同侧乳腺肿瘤复发及局部区域复发后的预后情况。

Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials.

作者信息

Wapnir Irene L, Anderson Stewart J, Mamounas Eleftherios P, Geyer Charles E, Jeong Jong-Hyeon, Tan-Chiu Elizabeth, Fisher Bernard, Wolmark Norman

机构信息

National Surgical Adjuvant Breast and Bowel Project Operations Office and Biostatistical Center, Pittsburgh, PA, USA.

出版信息

J Clin Oncol. 2006 May 1;24(13):2028-37. doi: 10.1200/JCO.2005.04.3273.

DOI:10.1200/JCO.2005.04.3273

PMID:16648502

Abstract

PURPOSE

Locoregional failure after breast-conserving surgery is associated with increased risk of distant disease and death. The magnitude of this risk in patients receiving chemotherapy has not been adequately characterized.

PATIENTS AND METHODS

Our study population included 2,669 women randomly assigned onto five National Surgical Adjuvant Breast and Bowel Project node-positive protocols (B-15, B-16, B-18, B-22, and B-25), who were treated with lumpectomy, whole-breast irradiation, and adjuvant systemic therapy. Cumulative incidences of ipsilateral breast tumor recurrence (IBTR) and other locoregional recurrence (oLRR) were calculated. Kaplan-Meier curves were used to estimate distant-disease-free survival (DDFS) and overall survival (OS) after IBTR or oLRR. Cox models were used to model survival using clinical and pathologic factors jointly with IBTR or oLRR as time-varying predictors.

RESULTS

Four hundred twenty-four patients (15.9%) experienced locoregional failure; 259 (9.7%) experienced IBTR, and 165 (6.2%) experienced oLRR. The 10-year cumulative incidence of IBTR and oLRR was 8.7% and 6.0%, respectively. Most locoregional failures occurred within 5 years (62.2% for IBTR and 80.6% for oLRR). Age, tumor size, and estrogen receptor status were significantly associated with IBTR. Nodal status and estrogen and progesterone receptor status were significantly associated with oLRR. The 5-year DDFS rates after IBTR and oLRR were 51.4% and 18.8%, respectively. The 5-year OS rates after IBTR and oLRR were 59.9% and 24.1%, respectively. Hazard ratios for mortality associated with IBTR and oLRR were 2.58 (95% CI, 2.11 to 3.15) and 5.85 (95% CI, 4.80 to 7.13), respectively.

CONCLUSION

Node-positive breast cancer patients who developed IBTR or oLRR had significantly poorer prognoses than patients who did not experience these events.

摘要

目的

保乳手术后局部区域复发与远处疾病和死亡风险增加相关。接受化疗患者的这种风险程度尚未得到充分描述。

患者与方法

我们的研究人群包括2669名女性，她们被随机分配到五个国家外科辅助乳腺和肠道项目的淋巴结阳性方案（B - 15、B - 16、B - 18、B - 22和B - 25）中，接受了肿块切除术、全乳照射和辅助全身治疗。计算同侧乳腺肿瘤复发（IBTR）和其他局部区域复发（oLRR）的累积发生率。采用Kaplan - Meier曲线估计IBTR或oLRR后的无远处疾病生存期（DDFS）和总生存期（OS）。使用Cox模型，将临床和病理因素与作为时间变化预测因子的IBTR或oLRR联合用于生存建模。

结果

424例患者（15.9%）发生局部区域复发；259例（9.7%）发生IBTR，165例（6.2%）发生oLRR。IBTR和oLRR的10年累积发生率分别为8.7%和6.0%。大多数局部区域复发发生在5年内（IBTR为62.2%，oLRR为80.6%）。年龄、肿瘤大小和雌激素受体状态与IBTR显著相关。淋巴结状态以及雌激素和孕激素受体状态与oLRR显著相关。IBTR和oLRR后的5年DDFS率分别为51.4%和18.8%。IBTR和oLRR后的5年OS率分别为59.9%和24.1%。与IBTR和oLRR相关的死亡风险比分别为2.58（95%CI，2.11至3.15）和5.85（95%CI，4.80至7.13）。