Tubiana-Hulin M, Le Doussal V, Hacene K, Rouëssé J, Brunet M
Dept. Medecine, Centre René Huguenin, Saint Cloud, France.
Cancer. 1993 Aug 15;72(4):1261-71. doi: 10.1002/1097-0142(19930815)72:4<1261::aid-cncr2820720419>3.0.co;2-4.
Predictors of distant relapse following conservative surgery for breast cancer were studied in a review of 425 women. Five steps of breast cancer patient management were defined in which increasing amounts of information, potentially relevant to prognosis for metastasis-free survival (MFS), were available: (1) clinical, (2) biopsy, (3) tumorectomy, (4) axillary dissection, and (5) adjuvant treatment. At each step, a prognosis study based on the Cox model was carried out using all acquired information from the first step.
Among the 21 studied variables, 5 were independent stable risk factors in predicting MFS: (1) clinical node status, (2) modified Scarff-Bloom-Richardson (MSBR) histoprognostic grade, (3) progesterone receptor (PR), (4) anatomic tumor size, and (5) histologic lymph node status. These factors were progressively identified throughout the successive prognostic analyses and kept their significance at the reference step (axillary dissection step where all information is acquired). According to the prognostic score based on the significant variables, a stratification of the patients had been built at each step, identifying three risk groups (low, moderate, high). Even at biopsy step, the mere knowledge of clinical information, such as clinical node status, and biopsy information, such as MSBR grade and PR status, would enable 68% of the patient to be well classified according to the stratification of reference. Knowledge of an additional factor, such as anatomic tumor size, would bring the rate up to 88%. Some subsets of patients with stable prognosis throughout the steps were identified and their profiles were described. It is noticeable that 95% of the patients, classified low risk at the biopsy step, were patients that were stable.
The early recognition of patients, highly curable by local therapy alone, would obviate aleatoric neoadjuvant treatment.
通过对425名女性的回顾性研究，探讨了乳腺癌保乳手术后远处复发的预测因素。定义了乳腺癌患者管理的五个阶段，在这些阶段中可获得越来越多可能与无转移生存（MFS）预后相关的信息：（1）临床阶段，（2）活检阶段，（3）肿瘤切除阶段，（4）腋窝淋巴结清扫阶段，以及（5）辅助治疗阶段。在每个阶段，使用从第一阶段获得的所有信息进行基于Cox模型的预后研究。
在研究的21个变量中，有5个是预测MFS的独立稳定风险因素：（1）临床淋巴结状态，（2）改良的斯卡夫-布卢姆-理查森（MSBR）组织学预后分级，（3）孕激素受体（PR），（4）肿瘤解剖学大小，以及（5）组织学淋巴结状态。这些因素在连续的预后分析中逐步被确定，并在参考阶段（获取所有信息的腋窝淋巴结清扫阶段）保持其显著性。根据基于显著变量的预后评分，在每个阶段对患者进行分层，确定了三个风险组（低、中、高）。即使在活检阶段，仅了解临床信息（如临床淋巴结状态）和活检信息（如MSBR分级和PR状态），就能使68%的患者根据参考分层得到良好分类。再了解一个额外因素（如肿瘤解剖学大小），这一比例将提高到88%。确定了在各个阶段预后稳定的一些患者亚组，并描述了他们的特征。值得注意的是，在活检阶段被归类为低风险的患者中，95%是预后稳定的患者。
早期识别仅通过局部治疗就具有高度治愈可能的患者，将避免随机的新辅助治疗。
