Dana-Farber Cancer Institute, Harvard School of Public Health, Boston, MA, USA.
J Clin Oncol. 2013 Sep 1;31(25):3083-90. doi: 10.1200/JCO.2012.46.1574. Epub 2013 Jul 29.
To retrospectively evaluate the pattern of recurrence and outcome of node-negative breast cancer (BC) according to major subtypes.
In all, 1,951 patients with node-negative, early-stage BC randomly assigned in International Breast Cancer Study Group Trials VIII and IX with centrally reviewed pathology data were included. BC subtypes were defined as triple negative (TN; n = 310), human epidermal growth factor receptor 2 (HER2) positive (n = 369), and hormone receptor positive with high (luminal B-like [LB-like]; n = 763) or low (luminal A-like [LA-like]; n = 509) proliferative activity by Ki-67 labeling index. BC-free interval (BCFI) events were invasive BC recurrence in local, contralateral breast, nodal, bone, or visceral sites. Time to first site-specific recurrence was evaluated by using cumulative incidence and competing risks regression analysis.
Median follow-up was 12.5 years. The 10-year BCFI was higher for patients with LA-like (86%) BC compared with LB-like (76%), HER2 (73%), and TN (71%; P < .001) BC. TN and HER2 cohorts had higher hazard of BCFI event in the first 4 years after diagnosis (pre-trastuzumab). LB-like cohorts had a continuously higher hazard of BCFI event over time compared with LA-like cohorts. Ten-year overall survival was higher for LA-like (89%) compared with LB-like (83%), HER2 (77%), and TN (75%; P < .001) BC. LB-like subtypes had higher rates of bone as first recurrence site than other subtypes (P = .005). Visceral recurrence as first site was lower for the LA-like subgroup, with similar incidence among the other subgroups when treated with chemotherapy (P = .003).
BC subtypes have different distant recurrence patterns over time. Defining different patterns of BC recurrence can improve BC care through surveillance guidelines and can guide the design of clinical studies.
回顾性评估根据主要亚型分类的淋巴结阴性乳腺癌（BC）的复发模式和结局。
共有 1951 例淋巴结阴性、早期 BC 患者入组国际乳腺癌研究组试验 VIII 和 IX，这些患者的病理数据经中心审查，可进行分析。BC 亚型定义为三阴性（TN；n=310）、人表皮生长因子受体 2（HER2）阳性（n=369），以及激素受体阳性伴高（管腔 B 样[LB 样]；n=763）或低（管腔 A 样[LA 样]；n=509）增殖活性的 Ki-67 标记指数。BC 无复发生存期（BCFI）事件为局部、对侧乳房、淋巴结、骨或内脏部位的浸润性 BC 复发。采用累积发生率和竞争风险回归分析评估首次特定部位复发的时间。
中位随访时间为 12.5 年。LA 样 BC 的 10 年 BCFI （86%）高于 LB 样（76%）、HER2（73%）和 TN（71%；P<0.001）BC。TN 和 HER2 队列在诊断后前 4 年（曲妥珠单抗前）BCFI 事件的危险度更高。LB 样队列的 BCFI 事件危险度随时间推移持续高于 LA 样队列。LA 样 BC 的 10 年总生存率（89%）高于 LB 样（83%）、HER2（77%）和 TN（75%；P<0.001）BC。LB 样亚型首次复发部位中骨转移的发生率高于其他亚型（P=0.005）。LA 样亚组内脏转移的发生率较低，而其他亚组在接受化疗时，内脏转移的发生率相似（P=0.003）。
BC 亚型在不同时间具有不同的远处复发模式。确定不同的 BC 复发模式可以通过监测指南改善 BC 护理，并可以指导临床研究的设计。
