Department of Surgery, Division of Surgical Oncology, University of California Davis, Sacramento, CA 95817, USA.
Med Oncol. 2010 Dec;27(4):1420-4. doi: 10.1007/s12032-009-9396-4. Epub 2010 Jan 5.
Institutional data are conflicting regarding the prognosis of breast cancer patients with extensive (≥10) axillary lymph node (ALN) metastases. We hypothesized that overall survival (OS) and disease specific survival (DSS) improved after the introduction of anthracycline-based therapy in 1997. We used the Surveillance, Epidemiology, and End results (SEER) database to identify breast cancer patients with ≥10 ALN metastases diagnosed between 1988 and 2004. Patients were categorized according to whether they were diagnosed prior to the FDA approval of anthracyclines (pre-anthracycline era, pre-AE) or after approval (post-anthracycline era, post-AE). Univariate analyses of OS and DSS were performed using the Kaplan-Meier method and differences assessed via the log rank test. Anthracycline era as an independent predictor of OS and DSS was evaluated using Cox proportional hazards models with patient age, hormone receptor status, tumor size, use of radiation therapy, and number of metastatic ALNs as covariates. Entry criteria were met by 12,653 patients. Of these, 5,655 (44.7%) and 6,998 (55.3%) were treated in the pre-AE and post-AE, respectively. On univariate analysis, post-AE patients experienced significantly improved rates of OS (P<0.001) and DSS (P<0.001) relative to pre-AE patients. On multivariate analysis, treatment in the post-AE favorably influenced both OS (Hazard Ratio [HR] 0.90, 95% Confidence Interval [CI] 0.84-0.96) and DSS (HR 0.84, CI 0.79-0.91). Both OS and DSS are poor in patients with extensive ALN metastases. Patients with advanced breast cancer treated in the post-AE demonstrated superior OS and DSS.
机构数据在乳腺癌患者广泛（≥10）腋窝淋巴结（ALN）转移的预后方面存在冲突。我们假设，1997 年引入蒽环类药物治疗后，总生存期（OS）和疾病特异性生存期（DSS）得到改善。我们使用监测、流行病学和最终结果（SEER）数据库来确定 1988 年至 2004 年期间诊断为≥10 个 ALN 转移的乳腺癌患者。根据患者是否在 FDA 批准蒽环类药物之前（蒽环类药物前时代，pre-AE）或之后（蒽环类药物后时代，post-AE）进行分类。使用 Kaplan-Meier 方法进行 OS 和 DSS 的单变量分析，并通过对数秩检验评估差异。使用 Cox 比例风险模型评估蒽环类药物时代作为 OS 和 DSS 的独立预测因子，将患者年龄、激素受体状态、肿瘤大小、放疗使用情况和转移性 ALN 数量作为协变量。符合入组标准的患者有 12653 例。其中，5655 例（44.7%）和 6998 例（55.3%）分别在 pre-AE 和 post-AE 中治疗。单变量分析显示，post-AE 患者的 OS（P<0.001）和 DSS（P<0.001）明显提高。多变量分析表明，post-AE 治疗对 OS（风险比 [HR] 0.90，95%置信区间 [CI] 0.84-0.96）和 DSS（HR 0.84，CI 0.79-0.91）均有有利影响。广泛 ALN 转移的患者 OS 和 DSS 均较差。在 post-AE 中治疗的晚期乳腺癌患者的 OS 和 DSS 均有改善。
