Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, DC.
Am J Clin Oncol. 2014 Aug;37(4):315-21. doi: 10.1097/COC.0b013e318271b34b.
To determine whether chemotherapy response and diagnostic delay affect overall survival (OS) of classic inflammatory breast cancer (IBC) cases receiving chemotherapy as initial treatment and to determine whether OS differs between classic and "atypical" IBC cases.
This is a prospective cohort study of 155 patients enrolled in the IBC Registry. "Classic" IBC cases met AJCC or SEER case definitions. "Atypical" IBC cases exhibited classic features but involved <1/2 breast without documented dermal lymphatic invasion. Variables included OS (years from initial chemotherapy treatment until death or last contact), chemotherapy response (complete, partial, or none), diagnostic delay (days from first medical contact for signs/symptoms of abnormal breast to definitive pathologic IBC diagnosis), age at diagnosis (y), and triple-negative status (yes or no). OS curves stratified by individual predictors were estimated and compared using Kaplan-Meier methods and log-rank tests. Associations between OS and predictors were examined collectively using Cox proportional hazards regression.
Classic IBC cases with complete, partial, or no response had respective median (95% confidence interval [CI]) OS times of 10.30 (6.78, +), 6.27 (4.42, +), and 2.86 (1.11, 11.42) years (P=0.0072). Chemotherapy response was significantly associated with OS after controlling for covariates (P=0.003). Women not responding to chemotherapy had a significantly higher hazard of death compared with women with complete (hazard ratio [HR]=5.76; 95% CI, 2.09-15.84) or partial (HR=3.40; 95% CI, 1.27-9.10) response. Diagnostic delay was not significantly associated with OS (HR=1.003; 95% CI, 0.999-1.007). OS did not differ significantly between classic and "atypical" IBC cases (P=0.60).
Response to standard IBC chemotherapy is a dominant prognostic factor in determining patient outcomes. In our study, with limited statistical power, delay in diagnosis defined as >60 days from the time of first physician contact did not seem to affect patient outcomes. Data support similarities between classic and "atypical" IBC.
确定化疗反应和诊断延迟是否影响接受初始化疗治疗的经典炎性乳腺癌（IBC）病例的总生存期（OS），并确定经典和“非典型”IBC 病例的 OS 是否存在差异。
这是一项对 155 名入组 IBC 登记处的患者进行的前瞻性队列研究。“经典”IBC 病例符合 AJCC 或 SEER 病例定义。“非典型”IBC 病例表现出经典特征，但累及<1/2 乳房且无记录的皮肤淋巴管浸润。变量包括 OS（从初始化疗治疗开始到死亡或最后一次接触的年数）、化疗反应（完全、部分或无）、诊断延迟（从首次出现异常乳房的体征/症状到明确的 IBC 诊断的天数）、诊断时年龄（岁）和三阴性状态（是或否）。使用 Kaplan-Meier 方法和对数秩检验估计按个体预测因素分层的 OS 曲线，并进行比较。使用 Cox 比例风险回归模型综合检查 OS 与预测因素的相关性。
完全、部分或无反应的经典 IBC 病例的中位（95%置信区间[CI]）OS 时间分别为 10.30（6.78，+）、6.27（4.42，+）和 2.86（1.11，11.42）年（P=0.0072）。在校正协变量后，化疗反应与 OS 显著相关（P=0.003）。与完全缓解（危险比[HR]=5.76；95%CI，2.09-15.84）或部分缓解（HR=3.40；95%CI，1.27-9.10）的女性相比，无化疗反应的女性死亡风险显著更高。诊断延迟与 OS 无显著相关性（HR=1.003；95%CI，0.999-1.007）。经典和“非典型”IBC 病例的 OS 无显著差异（P=0.60）。
对标准 IBC 化疗的反应是决定患者预后的主要预后因素。在我们的研究中，由于统计能力有限，从首次就诊到诊断的时间超过 60 天的诊断延迟似乎并未影响患者结局。数据支持经典和“非典型”IBC 之间的相似性。
