O'Reilly S M, Camplejohn R S, Barnes D M, Millis R R, Rubens R D, Richards M A
Imperial Cancer Research Fund Clinical Oncology Unit, Guy's Hospital, London, United Kingdom.
J Clin Oncol. 1990 Dec;8(12):2040-6. doi: 10.1200/JCO.1990.8.12.2040.
Adjuvant systemic therapy for women with node-negative breast cancer is most easily justified for those patients at highest risk of relapse. We have examined the impact of tumor size, histologic grade, estrogen receptor (ER) status, tumor ploidy, and S-phase fraction (SPF) on relapse-free survival (RFS) for 169 patients with node-negative breast cancer in order to identify groups of patients at high and low risk of relapse. Patients with small tumors (less than or equal to 1.0 cm) had a significantly better RFS than those with larger tumors (P = .005), with 96% remaining relapse-free at 5 years. Patients with tumors less than or equal to 1.0 cm were thus excluded from analysis when attempting to define a group with a poor prognosis. Within the group of patients with tumors greater than 1.0 cm, tumor ploidy (P = .63), ER status (P = .3), or progesterone receptor (PgR) status (P = .24) did not predict for RFS. Patients with grade 1 or 2 infiltrating ductal tumors had a significantly better prognosis than those with grade 3 tumors (P = .04). The prognostic factor that gave the widest separation between subgroups, however, was SPF. Patients whose tumors were greater than 1.0 cm with an SPF less than or equal to 10% had a 5-year RFS of 78% compared with a 5-year RFS of 52% for those with an SPF greater than 10% (P = .006). We have combined tumor size and SPF to identify three prognostic groups: (1) tumor less than or equal to 1.0 cm, 5-year RFS 96%; (2) tumor greater than 1.0 cm plus SPF less than or equal to 10%, 5-year RFS 78%; 3) tumor greater than 1.0 cm plus SPF greater than 10%, 5-year RFS 52%. These prognostic groupings may help identify patients most suitable for adjuvant therapy.
对于复发风险最高的那些淋巴结阴性乳腺癌女性患者，辅助性全身治疗最具合理性。我们研究了肿瘤大小、组织学分级、雌激素受体（ER）状态、肿瘤倍体以及S期细胞分数（SPF）对169例淋巴结阴性乳腺癌患者无复发生存期（RFS）的影响，以便确定复发风险高和低的患者组。肿瘤较小（小于或等于1.0 cm）的患者RFS明显优于肿瘤较大的患者（P = 0.005），5年时96%的患者无复发。因此，在试图定义预后不良组时，将肿瘤小于或等于1.0 cm的患者排除在分析之外。在肿瘤大于1.0 cm的患者组中，肿瘤倍体（P = 0.63）、ER状态（P = 0.3）或孕激素受体（PgR）状态（P = 0.24）均不能预测RFS。1级或2级浸润性导管癌患者的预后明显优于3级肿瘤患者（P = 0.04）。然而，在各亚组之间区分度最大的预后因素是SPF。肿瘤大于1.0 cm且SPF小于或等于10%的患者5年RFS为78%，而SPF大于10%的患者5年RFS为52%（P = 0.006）。我们将肿瘤大小和SPF结合起来确定了三个预后组：（1）肿瘤小于或等于1.0 cm，5年RFS为96%；（2）肿瘤大于1.0 cm且SPF小于或等于10%，5年RFS为78%；（3）肿瘤大于1.0 cm且SPF大于10%，5年RFS为52%。这些预后分组可能有助于识别最适合辅助治疗的患者。
