解剖分期和受体状态对 5 年内乳腺癌首次复发的影响（AFT-01）。
The influence of anatomic stage and receptor status on first recurrence for breast cancer within 5 years (AFT-01).
机构信息
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA.
出版信息
Cancer. 2023 May 1;129(9):1351-1360. doi: 10.1002/cncr.34656. Epub 2023 Mar 6.
BACKGROUND
Risk-stratified follow-up guidelines that account for the absolute risk and timing of recurrence may improve the quality and efficiency of breast cancer follow-up. The objective of this study was to assess the relationship of anatomic stage and receptor status with timing of the first recurrence for patients with local-regional breast cancer and generate risk-stratified follow-up recommendations.
METHODS
The authors conducted a secondary analysis of 8007 patients with stage I-III breast cancer who enrolled in nine Alliance legacy clinical trials from 1997 to 2013 (ClinicalTrials.gov identifier NCT02171078). Patients who received standard-of-care therapy were included. Patients who were missing stage or receptor status were excluded. The primary outcome was days from the earliest treatment start date to the date of first recurrence. The primary explanatory variable was anatomic stage. The analysis was stratified by receptor type. Cox proportional-hazards regression models produced cumulative probabilities of recurrence. A dynamic programming algorithm approach was used to optimize the timing of follow-up intervals based on the timing of recurrence events.
RESULTS
The time to first recurrence varied significantly between receptor types (p < .0001). Within each receptor type, stage influenced the time to recurrence (p < .0001). The risk of recurrence was highest and occurred earliest for estrogen receptor (ER)-negative/progesterone receptor (PR)-negative/Her2neu-negative tumors (stage III; 5-year probability of recurrence, 45.5%). The risk of recurrence was lower for ER-positive/PR-positive/Her2neu-positive tumors (stage III; 5-year probability of recurrence, 15.3%), with recurrences distributed over time. Model-generated follow-up recommendations by stage and receptor type were created.
CONCLUSIONS
This study supports considering both anatomic stage and receptor status in follow-up recommendations. The implementation of risk-stratified guidelines based on these data has the potential to improve the quality and efficiency of follow-up.
背景
考虑到复发的绝对风险和时间的风险分层随访指南可能会提高乳腺癌随访的质量和效率。本研究的目的是评估局部区域性乳腺癌患者的解剖分期和受体状态与首次复发时间的关系，并制定风险分层随访建议。
方法
作者对 1997 年至 2013 年期间参加 9 项联盟遗留临床试验的 8007 例 I-III 期乳腺癌患者进行了二次分析（ClinicalTrials.gov 标识符 NCT02171078）。纳入接受标准治疗的患者。排除缺失分期或受体状态的患者。主要结局为从最早治疗开始日期到首次复发日期的天数。主要解释变量为解剖分期。分析按受体类型分层。Cox 比例风险回归模型产生复发累积概率。使用动态编程算法方法根据复发事件的时间优化随访间隔的时间。
结果
受体类型之间首次复发的时间差异显著（p<0.0001）。在每个受体类型内，分期影响复发时间（p<0.0001）。雌激素受体（ER）阴性/孕激素受体（PR）阴性/Her2neu 阴性肿瘤的复发风险最高且最早（III 期；5 年复发概率，45.5%）。ER 阳性/PR 阳性/Her2neu 阳性肿瘤的复发风险较低（III 期；5 年复发概率，15.3%），且复发时间分布较广。根据分期和受体类型创建了模型生成的随访建议。
结论
本研究支持在随访建议中同时考虑解剖分期和受体状态。基于这些数据实施风险分层指南有可能提高随访的质量和效率。
Zotero 插件