Huseby R A, Ownby H E, Frederick J, Brooks S, Russo J, Brennan M J
Department of Biochemistry School of Medicine, Loma Linda University, CA.
J Clin Oncol. 1988 Jan;6(1):83-8. doi: 10.1200/JCO.1988.6.1.83.
The present study attempts to identify poor prognosis subgroups of women with node-negative breast cancer that might benefit from systemic adjuvant therapy. The cases were collected through a cooperative effort of 57 surgeons at eight hospitals in the Detroit area and coordinated by the Michigan Cancer Foundation where data collection and analyses were completed. The primary treatment of all patients was a modified radical mastectomy. Of the 1,078 cases accessioned between October 1975 and April 1983, 537 were found to have no microscopic lymph node involvement and 462 of these cases received no adjuvant antineoplastic therapy. The period of follow-up of these cases (alive, n = 358) has been 78.75 +/- 24.6 months (mean +/- SD). Overall, the cumulative 6-year recurrence rate as calculated by life table analysis was 26%, with 16.8% dying of their disease. Tumor size was an important prognostic factor; the recurrence rate was 16.2% for those with primaries measuring less than or equal to 1 cm, with only a 6.3% mortality. Patients with tumors measuring greater than 5 cm also did well: 13.7% recurrence and 13.7% mortality rates at 6 years. The premenopausal women did slightly, but not statistically significantly, better than those who were postmenopausal. The presence or absence of quantifiable estrogen receptor protein (ER) was of little predictive value as far as rates of recurrence were concerned, but patients with an ER-positive tumor survived significantly longer. In postmenopausal women, those whose tumor lacked ER (n = 112) fared poorly: 30.4% experienced a recurrence by 6 years and 28% died of their disease. Recurrence rates and death rates were also high in a small group (n = 35) of postmenopausal women with ER+ tumors exhibiting nuclear pleomorphism (nuclear grade [NG]3) (38% and 24.3%, respectively). No poor prognosis group of premenopausal women was identified.
本研究试图确定可能从全身辅助治疗中获益的淋巴结阴性乳腺癌女性的预后不良亚组。这些病例是通过底特律地区八家医院的57位外科医生的合作努力收集的，并由密歇根癌症基金会协调，在那里完成了数据收集和分析。所有患者的主要治疗方法是改良根治性乳房切除术。在1975年10月至1983年4月期间登记的1078例病例中，发现537例无微小淋巴结受累，其中462例未接受辅助抗肿瘤治疗。这些病例（存活，n = 358）的随访期为78.75±24.6个月（平均值±标准差）。总体而言，通过生命表分析计算的累积6年复发率为26%，16.8%死于该病。肿瘤大小是一个重要的预后因素；原发肿瘤小于或等于1 cm的患者复发率为16.2%，死亡率仅为6.3%。肿瘤大于5 cm的患者情况也较好：6年时复发率和死亡率均为13.7%。绝经前女性的情况略好于绝经后女性，但无统计学显著差异。就复发率而言，可量化雌激素受体蛋白（ER）的有无几乎没有预测价值，但ER阳性肿瘤患者的存活时间明显更长。在绝经后女性中，肿瘤缺乏ER的患者（n = 112）预后较差：6年时30.4%复发，28%死于该病。一小部分（n = 35）绝经后ER+肿瘤表现出核多形性（核分级[NG]3）的女性的复发率和死亡率也很高（分别为38%和24.3%）。未发现绝经前女性的预后不良亚组。
