Nguyen Paul L, Taghian Alphonse G, Katz Matthew S, Niemierko Andrzej, Abi Raad Rita F, Boon Whitney L, Bellon Jennifer R, Wong Julia S, Smith Barbara L, Harris Jay R
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
J Clin Oncol. 2008 May 10;26(14):2373-8. doi: 10.1200/JCO.2007.14.4287. Epub 2008 Apr 14.
To determine whether breast cancer subtype is associated with outcome after breast-conserving therapy (BCT) consisting of lumpectomy and radiation therapy.
We studied 793 consecutive patients with invasive breast cancer who received BCT from July 1998 to December 2001. Among them, 97% had pathologically negative margins of resection, and 90% received adjuvant systemic therapy. No patient received adjuvant trastuzumab. Receptor status was used to approximate subtype: estrogen receptor (ER) or progesterone receptor (PR) positive and human epidermal growth factor receptor 2 negative = luminal A; ER+ or PR+ and HER-2+ = luminal B; ER-and PR -and HER-2+ = HER-2; and ER-and PR -and HER-2-= basal. Competing risks methodology was used to analyze time to local recurrence and distant metastases.
Median follow-up was 70 months. The overall 5-year cumulative incidence of local recurrence was 1.8% (95% CI, 1.0 to 3.1); 0.8% (0.3, 2.2) for luminal A, 1.5% (0.2, 10) for luminal B, 8.4% (2.2, 30) for HER-2, and 7.1% (3.0, 16) for basal. On multivariable analysis (MVA) with luminal A as baseline, HER-2 (adjusted hazard ratio [AHR] = 9.2; 95% CI, 1.6 to 51; P = .012) and basal (AHR = 7.1; 95% CI, 1.6 to 31; P = .009) subtypes were associated with increased local recurrence. On MVA, luminal B (AHR = 2.9; 95% CI, 1.3 to 6.5; P = .007) and basal (AHR = 2.3; 95% CI, 1.1 to 5.2; P = .035) were associated with increased distant metastases.
Overall, the 5-year local recurrence rate after BCT was low, but varied by subtype as approximated using ER, PR, and HER-2 status. Local recurrence was particularly low for the luminal A subtype, but was less than 10% at 5 years for all subtypes. Although further follow-up is needed, these results may be useful in counseling patients about their anticipated outcome after BCT.
确定乳腺癌亚型是否与保乳治疗（BCT，包括乳房肿瘤切除术和放射治疗）后的预后相关。
我们研究了1998年7月至2001年12月期间连续接受BCT的793例浸润性乳腺癌患者。其中，97%的患者手术切缘病理阴性，90%的患者接受了辅助全身治疗。无一例患者接受辅助曲妥珠单抗治疗。受体状态用于近似亚型：雌激素受体（ER）或孕激素受体（PR）阳性且人表皮生长因子受体2阴性=腔面A型；ER+或PR+且HER-2+ =腔面B型；ER-且PR-且HER-2+ =HER-2型；ER-且PR-且HER-2- =基底型。采用竞争风险方法分析局部复发和远处转移时间。
中位随访时间为70个月。局部复发的总体5年累积发生率为1.8%（95%CI，1.0至3.1）；腔面A型为0.8%（0.3，2.2），腔面B型为1.5%（0.2，10），HER-2型为8.4%（2.2，30），基底型为7.1%（3.0，16）。以腔面A型为基线进行多变量分析（MVA），HER-2型（调整后风险比[AHR]=9.2；95%CI，1.6至51；P=.012）和基底型（AHR=7.1；95%CI，1.6至31；P=.009）亚型与局部复发增加相关。在MVA中，腔面B型（AHR=2.9；95%CI，1.3至6.5；P=.007）和基底型（AHR=2.3；95%CI，1.1至5.2；P=.035）与远处转移增加相关。
总体而言，BCT后的5年局部复发率较低，但根据ER、PR和HER-2状态近似的亚型有所不同。腔面A型的局部复发率特别低，但所有亚型在5年时均低于10%。尽管需要进一步随访，但这些结果可能有助于为患者提供有关BCT后预期预后的咨询。
