Attia-Sobol J, Ferrière J P, Curé H, Kwiatkowski F, Achard J L, Verrelle P, Feillel V, De Latour M, Lafaye C, Deloche C
Centre Jean Perrin, Clermont-Ferrand, France.
Eur J Cancer. 1993;29A(8):1081-8. doi: 10.1016/s0959-8049(05)80292-8.
Between 1978 and 1987, 109 patients without metastatic disease were treated by induction chemotherapy for inflammatory breast cancer (IBC) or "neglected" locally advanced breast cancer (LABC): 62 patients had a clinical history of rapidly growing tumours (doubling time < or = 4 months) and inflammatory signs; conversely, the 47 neglected patients had local inflammation with a longer history of LABC. 103 patients were fully evaluable. All patients received the same induction chemotherapy with doxorubicin, vincristine, cyclophosphamide and 5-fluorouracil. After six cycles, locoregional treatment was by radiotherapy if a complete or nearly complete response had been obtained, and total mastectomy, with pre or postoperative radiotherapy, in other cases. The chemotherapy after local treatment comprised of six cycles for LABC and 12 cycles for IBC (six without doxorubicin). With a median follow-up of 120 months, the median overall survival (OS) time was 70 months as against 45 months for disease-free survival (DFS). No difference was observed for OS and DFS between LABC and IBC. The regional recurrence rate was 24% (15% for radiotherapy alone). 20 factors of potential prognostic significance were evaluated by univariate and multivariate analysis. For DFS and OS, univariate analysis suggested a worse prognostic significance for "peau d'orange" appearance of the skin, clinical evidence of node involvement and poor response to chemotherapy after three cycles, on mammographic criteria. The cumulative dose of doxorubicin after three cycles seemed to have a significant effect on OS (P < 0.03) but was too closely correlated with age to draw definite conclusions. In the multivariate analysis, "peau d'orange", menopausal status and clinical node involvement predicted DFS. "Peau d'orange" and clinical node involvement also predicted OS. Our results indicate that IBC and LABC do not behave differently when treated with our procedure.
1978年至1987年间，109例无转移性疾病的患者接受了诱导化疗，治疗的疾病为炎性乳腺癌（IBC）或“被忽视的”局部晚期乳腺癌（LABC）：62例患者有肿瘤快速生长（倍增时间≤4个月）及炎性体征的临床病史；相反，47例被忽视的患者有局部炎症，且LABC病史较长。103例患者可进行全面评估。所有患者均接受相同的含阿霉素、长春新碱、环磷酰胺和5-氟尿嘧啶的诱导化疗。六个周期后，若获得完全或近乎完全缓解，则通过放疗进行局部区域治疗，其他情况则行全乳切除术，并进行术前或术后放疗。局部治疗后的化疗，LABC为六个周期，IBC为12个周期（六个周期不含阿霉素）。中位随访120个月，中位总生存期（OS）为70个月，无病生存期（DFS）为45个月。LABC和IBC之间在OS和DFS方面未观察到差异。区域复发率为24%（单纯放疗为15%）。通过单因素和多因素分析评估了20个可能具有预后意义的因素。对于DFS和OS，单因素分析表明，根据乳房X线摄影标准，皮肤“橘皮样”外观、淋巴结受累的临床证据以及三个周期化疗后反应不佳具有更差的预后意义。三个周期后阿霉素的累积剂量似乎对OS有显著影响（P<0.03），但与年龄密切相关，无法得出明确结论。在多因素分析中，“橘皮样”改变、绝经状态和临床淋巴结受累可预测DFS。“橘皮样”改变和临床淋巴结受累也可预测OS。我们的结果表明，采用我们的治疗方法时，IBC和LABC的表现没有差异。
