Mansell James, Monypenny Ian J, Skene Anthony I, Abram Paul, Carpenter Robert, Gattuso Jennifer M, Wilson Christopher R, Angerson Wilson J, Doughty Julie C
University Department of Surgery, Western Infirmary, Glasgow, Scotland, UK.
Breast Cancer Res Treat. 2009 Sep;117(1):91-8. doi: 10.1007/s10549-008-0291-z. Epub 2008 Dec 27.
Previous studies suggest that disease recurrence peaks at around 2 years in patients with early stage breast cancer (EBC), but provide no data regarding recurrence type. This retrospective analysis aimed to identify early recurrence types and risk factors in estrogen receptor-positive (ER+) EBC patients treated with adjuvant tamoxifen following breast cancer surgery. Postmenopausal women diagnosed with ER+ EBC from 1995 to 2004 were evaluated. Annual hazard ratios (HR) for recurrence at different sites were calculated. Time-dependent Cox regression analysis was used to identify predictors of recurrence within 2.5 years of diagnosis, including factors that were more strongly predictive of early than later recurrence. Of 3,614 patients evaluated, 476 developed recurrence during the 5-year median follow-up. Cumulative recurrence rates at 2.5 years (95% confidence interval) were: overall 6.3% (5.5-7.1), locoregional 1.1% (0.7-1.5), contralateral 0.5% (0.3-0.7), and distant 4.8% (4.0-5.6). The annual HR of overall recurrence peaked at 2 years (4.3% per annum). The majority of this peak represented distant recurrence (3.4% per annum). In Cox regression analysis, tumor size and grade, lymph node involvement, lymphovascular invasion, and symptomatic presentation were significant independent predictors of early recurrence. Age at diagnosis was independently predictive of recurrence within 2.5 years of diagnosis but not later recurrence. This study identified an early recurrence peak at 2 years, most of which were distant recurrences. Implementing an aromatase inhibitor after an initial 2-3 years of tamoxifen fails to address this early peak of distant recurrence and the potential breast cancer-associated mortality.
既往研究表明，早期乳腺癌（EBC）患者的疾病复发高峰出现在2年左右，但未提供关于复发类型的数据。本回顾性分析旨在确定接受乳腺癌手术后辅助他莫昔芬治疗的雌激素受体阳性（ER+）EBC患者的早期复发类型及危险因素。对1995年至2004年诊断为ER+ EBC的绝经后女性进行了评估。计算了不同部位复发的年度风险比（HR）。采用时间依赖性Cox回归分析来确定诊断后2.5年内复发的预测因素，包括比晚期复发更能强烈预测早期复发的因素。在评估的3614例患者中，476例在5年中位随访期间出现复发。2.5年时的累积复发率（95%置信区间）为：总体6.3%（5.5 - 7.1），局部区域1.1%（0.7 - 1.5），对侧0.5%（0.3 - 0.7），远处4.8%（4.0 - 5.6）。总体复发的年度HR在2年时达到峰值（每年4.3%）。该峰值的大部分代表远处复发（每年3.4%）。在Cox回归分析中，肿瘤大小和分级、淋巴结受累、淋巴管浸润和症状表现是早期复发的显著独立预测因素。诊断时的年龄是诊断后2.5年内复发的独立预测因素，但不是晚期复发的预测因素。本研究确定了2年时的早期复发高峰，其中大部分是远处复发。在他莫昔芬初始治疗2 - 3年后应用芳香化酶抑制剂并不能解决这种早期远处复发高峰以及潜在的乳腺癌相关死亡率问题。
