Nakano Masahiro, Fujisue Mamiko, Tashima Rumiko, Okumura Yasuhiro, Nishiyama Yasuyuki, Ohsako Tomofumi, Toyozumi Yasuo, Arima Nobuyuki, Nishimura Reiki
Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60, Kotoh, Higashi-ku, Kumamoto 860-8505, Japan.
Department of Breast and Endocrine Surgery, Kumamoto City Hospital, 1-1-60, Kotoh, Higashi-ku, Kumamoto 860-8505, Japan.
Breast. 2015 Oct;24(5):588-93. doi: 10.1016/j.breast.2015.06.003. Epub 2015 Jun 20.
Survival for patients with recurrent breast cancer has improved over time due to the introduction of modern systemic therapy. The aim of this study was to determine the impact of subtype and the year of recurrence on the survival times of recurrent breast cancer.
Between 1979 and 2013, 813 patients who underwent initial treatment for primary breast cancer experienced recurrence. They were divided into two groups based on the year of recurrence; before 2000 and after 2001. Survival after recurrence was compared between these groups based on following criteria; subtypes, disease free interval (DFI), and dominant recurrent site. The median follow-up period after recurrence was 4.3 years.
Survival improved significantly in the after 2001 group, and a significant improvement in survival was only seen in the HER2-enriched subtype. Multivariate analysis revealed that DFI, ER, HER2 status, dominant recurrent site and the Ki-67 index value were significant prognostic factors. In the HER2-enriched subtype, the year of recurrence, DFI and dominant recurrent site were significant independent factors. In the other subtypes, these factors were not correlated with survival.
Our study revealed that the survival rate of patients with only the HER2-enriched subtype significantly improved after recurrence. To prolong the survival time after recurrence of both luminal and triple negative subtypes, the development of novel targeting therapies to overcome refractory recurrent breast cancer is extremely important.
由于现代全身治疗方法的引入，复发性乳腺癌患者的生存率随时间有所提高。本研究的目的是确定亚型和复发年份对复发性乳腺癌生存时间的影响。
1979年至2013年间，813例接受原发性乳腺癌初始治疗的患者出现复发。根据复发年份将他们分为两组：2000年之前和2001年之后。根据以下标准比较两组复发后的生存率：亚型、无病生存期（DFI）和主要复发部位。复发后的中位随访期为4.3年。
2001年后组的生存率显著提高，且仅在HER2富集亚型中观察到生存率有显著改善。多因素分析显示，DFI、雌激素受体（ER）、HER2状态、主要复发部位和Ki-67指数值是显著的预后因素。在HER2富集亚型中，复发年份、DFI和主要复发部位是显著的独立因素。在其他亚型中，这些因素与生存率无关。
我们的研究表明，仅HER2富集亚型患者复发后的生存率显著提高。为延长管腔型和三阴性亚型复发后的生存时间，开发新型靶向疗法以克服难治性复发性乳腺癌极为重要。
