Grupo Oncológico Cooperativo del Sur (GOCS), Neuquén, Argentina.
Breast J. 2011 Nov-Dec;17(6):630-7. doi: 10.1111/j.1524-4741.2011.01157.x.
Most cases of breast cancer are diagnosed at early stage of disease; therefore, treatment is oriented to increase the disease-free interval (DFI) and overall survival (OS). The prognosis, in comparison with other malignancies, has improved in the last decades as a result of mammographic screening. The aim of the study was to report the incidence of local and distant recurrence, DFI and OS in patients (pts) with stage I and stage II breast cancer over a period of 26 years divided into three groups. From January 1978 to December 2004, 927 women with early breast cancer (EBC) were included, 350 were stage I and 577 Stage II (AJCC 2002). Patients were divided according to the year of diagnosis into three periods of 10 years: Group A (1978-1987) 135 pts, Group B (1988-1997) 412 pts, and Group C (1998-2004) 380 pts. DFI was analyzed from the date of initial diagnosis to the date of local or distant recurrence. OS was estimated from the date of initial diagnosis to the last follow-up or date of death. Median age was 51 years (28-92). Conservative surgery was performed in 69% of pts, adjuvant radiation therapy in 78%, adjuvant chemotherapy in 29%, and adjuvant hormone therapy in 18%. The median follow-up was 8.4 years (0.3-30). The mean tumor size in Group A was 2.7 cm, in Group B 2.2 cm, and in Group C 1.94 cm (p = 0.0001). The percentage of pts with stage I increased from 13% in Group A to 38% in Group B and to 47% in Group C (p = 0.0001). Local recurrence was documented in 5% of all pts, whereas 28% developed metastatic disease. The DFI and OS showed a statistically significant difference among the three groups (p = 0.005). DFI rate at 5, 10, 15, 20, and 25 years was 71%, 67%, 65%, 65%, and 64%, respectively. OS at 5, 10, 15, 20, and 25 years was 82%, 62%, 49%, 39%, and 28%, respectively. Factors that had an effect in OS demonstrated by the multivariate regression analysis were: Tumor size, ER status, and nodal involvement (p < 0.001). Clinical outcomes in EBC in our experience are similar to those reported in international literature. The DFI and OS showed a statistically significant difference among the three groups. This group of pts continues to have a good prognosis as shown by the OS rate at 5, 10, 15, 20, and 25 years, although a high percentage of pts still to have recurrence and die from breast cancer after 5, 10, 15, 20, and 25 years of follow-up.
大多数乳腺癌病例在疾病早期被诊断出来；因此，治疗方向是增加无病间隔期（DFI）和总生存期（OS）。与其他恶性肿瘤相比，由于乳房 X 线筛查，过去几十年的预后已经有所改善。本研究的目的是报告 I 期和 II 期乳腺癌患者（pts）的局部和远处复发、DFI 和 OS 的发生率，这些患者在 26 年的时间内分为三组。从 1978 年 1 月至 2004 年 12 月，共纳入 927 例早期乳腺癌（EBC）患者，其中 350 例为 I 期，577 例为 II 期（AJCC 2002）。根据诊断年份将患者分为三个 10 年组：A 组（1978-1987 年）135 例，B 组（1988-1997 年）412 例，C 组（1998-2004 年）380 例。DFI 从初始诊断日期到局部或远处复发日期进行分析。OS 从初始诊断日期到最后随访或死亡日期进行评估。中位年龄为 51 岁（28-92 岁）。69%的 pts 接受了保乳手术，78%接受了辅助放疗，29%接受了辅助化疗，18%接受了辅助激素治疗。中位随访时间为 8.4 年（0.3-30 年）。A 组的平均肿瘤大小为 2.7cm，B 组为 2.2cm，C 组为 1.94cm（p=0.0001）。I 期 pts 的比例从 A 组的 13%增加到 B 组的 38%和 C 组的 47%（p=0.0001）。所有 pts 中有 5%发生局部复发，28%发生转移性疾病。三组之间 DFI 和 OS 存在统计学差异（p=0.005）。5、10、15、20 和 25 年的 DFI 率分别为 71%、67%、65%、65%和 64%。5、10、15、20 和 25 年的 OS 率分别为 82%、62%、49%、39%和 28%。多变量回归分析显示，影响 OS 的因素有：肿瘤大小、ER 状态和淋巴结受累（p<0.001）。我们的经验表明，EBC 的临床结果与国际文献报道的相似。DFI 和 OS 在三组之间存在统计学差异。这组患者的预后仍然较好，5、10、15、20 和 25 年的 OS 率表明这一点，尽管仍有很大比例的患者在 5、10、15、20 和 25 年的随访后仍有复发和死于乳腺癌。
