Karlsson Per, Cole Bernard F, Price Karen N, Coates Alan S, Castiglione-Gertsch Monica, Gusterson Barry A, Murray Elizabeth, Lindtner Jurij, Collins John P, Holmberg Stig B, Fey Martin F, Thürlimann Beat, Crivellari Diana, Forbes John F, Gelber Richard D, Goldhirsch Aron, Wallgren Arne
Department of Oncology, University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden.
J Clin Oncol. 2007 May 20;25(15):2019-26. doi: 10.1200/JCO.2006.09.8152. Epub 2007 Apr 9.
To identify groups of early breast cancer patients with substantial risk (10-year risk > 20%) for locoregional failure (LRF) who might benefit from postmastectomy radiotherapy (RT).
Prognostic factors for LRF were evaluated among 6,660 patients (2,588 node-negative patients, 4,072 node-positive patients) in International Breast Cancer Study Group Trials I to IX treated with chemotherapy and/or endocrine therapy, and observed for a median of 14 years. In total, 1,251 LRFs were detected. All patients were treated with mastectomy without RT.
No group with 10-year LRF risk exceeding 20% was found among patients with node-negative disease. Among patients with node-positive breast cancer, increasing numbers of uninvolved nodes were significantly associated with decreased risk of LRF, even after adjustment for other prognostic factors. The highest quartile of uninvolved nodes was compared with the lowest quartile. Among premenopausal patients, LRF risk was decreased by 35% (P = .0010); among postmenopausal patients, LRF risk was decreased by 46% (P < .0001). The 10-year cumulative incidence of LRF was 20% among patients with one to three involved lymph nodes and fewer than 10 uninvolved nodes. Age younger than 40 years and vessel invasion were also associated significantly with increased risk. Among patients with node-positive disease, overall survival was significantly greater in those with higher numbers of uninvolved nodes examined (P < .0001).
Patients with one to three involved nodes and a low number of uninvolved nodes, vessel invasion, or young age have an increased risk of LRF and may be candidates for a similar treatment as those with at least four lymph node metastases.
识别局部区域复发（LRF）风险较高（10年风险>20%）的早期乳腺癌患者群体，这些患者可能从乳房切除术后放疗（RT）中获益。
在国际乳腺癌研究组试验I至IX中，对6660例接受化疗和/或内分泌治疗的患者（2588例淋巴结阴性患者，4072例淋巴结阳性患者）进行LRF预后因素评估，并进行了中位14年的观察。共检测到1251例LRF。所有患者均接受了乳房切除术，未进行放疗。
在淋巴结阴性疾病患者中，未发现10年LRF风险超过20%的群体。在淋巴结阳性乳腺癌患者中，即使在调整其他预后因素后，未受累淋巴结数量增加与LRF风险降低显著相关。将未受累淋巴结最高四分位数与最低四分位数进行比较。在绝经前患者中，LRF风险降低了35%（P = .0010）；在绝经后患者中，LRF风险降低了46%（P < .0001）。在有1至3个受累淋巴结且未受累淋巴结少于10个的患者中，LRF的10年累积发生率为20%。年龄小于40岁和血管侵犯也与风险增加显著相关。在淋巴结阳性疾病患者中，检查时未受累淋巴结数量较多的患者总生存率显著更高（P < .0001）。
有1至3个受累淋巴结且未受累淋巴结数量少、血管侵犯或年龄小的患者LRF风险增加，可能是与至少有4个淋巴结转移患者接受类似治疗的候选者。
