Ahmann F R, Jones S E, Moon T E
Section of Hematology and Oncology, Tucson VA Medical Center, Arizona 85723.
J Surg Oncol. 1988 Feb;37(2):116-22. doi: 10.1002/jso.2930370211.
Some adjuvantly treated patients develop recurrent breast cancer and little is known about the effect of prior adjuvant chemotherapy on subsequent response rates to systemic therapy or on overall survival. We describe our retrospective comparison of 179 patients who received doxorubicin containing adjuvant chemotherapy and developed recurrent breast cancer on University of Arizona Cancer Center clinical trials with 202 non-adjuvantly treated patients entered onto clinical protocols for recurrent or metastatic breast cancer during the same period. Adjuvant failures had a shorter median survival from the date of onset of recurrent disease (18 months versus 28 months, P less than 0.001), a lower response rate to initial combination chemotherapy (38% versus 69%, P = 0.001), and a high incidence of CNS involvement at the time of relapse (11%). In patients having recurrent or metastatic breast cancer, a history of prior adjuvant chemotherapy appears to identify a subgroup who will have a higher incidence of CNS involvement, a lower response rate to chemotherapy and a shorter survival with metastatic disease. These findings may help explain the failure of improved relapse free survival seen in many adjuvant chemotherapy trials to result in improved overall survival.
一些接受过辅助治疗的患者会出现复发性乳腺癌，而关于先前辅助化疗对后续全身治疗反应率或总生存期的影响，人们知之甚少。我们对179例接受含阿霉素辅助化疗且在亚利桑那大学癌症中心临床试验中出现复发性乳腺癌的患者，与同期进入复发性或转移性乳腺癌临床方案的202例未接受辅助治疗的患者进行了回顾性比较。辅助治疗失败的患者从复发性疾病发病之日起的中位生存期较短（18个月对28个月，P<0.001），对初始联合化疗的反应率较低（38%对69%，P=0.001），且复发时中枢神经系统受累的发生率较高（11%）。在患有复发性或转移性乳腺癌的患者中，先前辅助化疗史似乎可确定一个亚组，该亚组中枢神经系统受累的发生率较高、对化疗的反应率较低且转移性疾病的生存期较短。这些发现可能有助于解释许多辅助化疗试验中无复发生存期改善但总生存期未改善的原因。
