Yen Tina W F, Kuerer Henry M, Ottesen Rebecca A, Rouse Layla, Niland Joyce C, Edge Stephen B, Theriault Richard L, Weeks Jane C
Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
J Clin Oncol. 2007 Aug 1;25(22):3251-8. doi: 10.1200/JCO.2006.10.2699. Epub 2007 Jun 18.
The National Surgical Adjuvant Breast and Bowel Project B-24 trial, published in June 1999, demonstrated that tamoxifen after breast-conserving surgery (BCS) and radiotherapy for ductal carcinoma in situ (DCIS) reduced the absolute occurrence of ipsilateral and contralateral breast cancer. We assessed the impact of B-24 on practice patterns at selected National Comprehensive Cancer Network (NCCN) centers.
Tamoxifen use after surgery was examined among 1,622 patients presenting for treatment of unilateral DCIS between July 1997 and December 2003 at eight NCCN centers. Associations of clinicopathologic and treatment factors with tamoxifen use were assessed in univariate and multivariable logistic regression analyses.
Overall, 41% of patients (665 of 1,622) received tamoxifen. The proportion increased from 24% before July 1, 1999, to 46% on or after July 1, 1999. Factors significantly associated with receipt of tamoxifen included diagnosis on or after July 1, 1999 (odds ratio [OR], 3.85; P < .0001), BCS in patients younger than 70 years (OR, 3.21; P = .0073), no history of cerebrovascular or peripheral vascular disease (OR, 3.13; P = .0071), receipt of radiotherapy (OR, 1.82; P = .0009), and previous hysterectomy (OR, 1.34; P = .0459). Tamoxifen use varied significantly by center, from 34% to 74% after BCS and 17% to 53% after mastectomy (P < .0001).
Tamoxifen use after surgery for DCIS at NCCN centers increased after presentation of the B-24 results. Rates varied substantially by institution, suggesting that physicians differ in how they weigh the modest reduction in breast cancer risk with tamoxifen against its potential adverse effects in this population.
1999年6月发表的国家外科辅助乳腺和肠道项目B - 24试验表明，保乳手术（BCS）和放疗后使用他莫昔芬治疗导管原位癌（DCIS）可降低同侧和对侧乳腺癌的绝对发生率。我们评估了B - 24试验对部分美国国立综合癌症网络（NCCN）中心的临床实践模式的影响。
1997年7月至2003年12月期间，在8个NCCN中心对1622例单侧DCIS患者进行手术治疗后使用他莫昔芬的情况进行了检查。在单因素和多因素逻辑回归分析中评估了临床病理和治疗因素与他莫昔芬使用之间的关联。
总体而言，41%的患者（1622例中的665例）接受了他莫昔芬治疗。这一比例从1999年7月1日前的24%增加到1999年7月1日及以后的46%。与接受他莫昔芬治疗显著相关的因素包括1999年7月1日及以后的诊断（比值比[OR]，3.85；P <.0001）、70岁以下患者的保乳手术（OR，3.21；P =.0073）、无脑血管或外周血管疾病史（OR，3.13；P =.0071）、接受放疗（OR，1.82；P =.0009）以及既往子宫切除术（OR，1.34；P =.0459）。他莫昔芬的使用在各中心之间存在显著差异，保乳手术后为34%至74%，乳房切除术后为17%至53%（P <.0001）。
B - 24试验结果公布后，NCCN中心DCIS手术后他莫昔芬的使用增加。各机构的使用率差异很大，这表明医生在权衡他莫昔芬对乳腺癌风险的适度降低与其在该人群中的潜在不良反应时存在差异。
