Haas J A, Schultz D J, Peterson M E, Solin L J
Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, USA.
Cancer J Sci Am. 1998 Sep-Oct;4(5):308-15.
The present study reports the effects of patient age and family history on outcome after breast-conservation treatment. In addition, the interaction of age and family history is examined to determine outcome for younger patients with a positive family history of breast cancer (i.e., at a higher risk of having the BRCA1 or BRCA2 gene) after breast-conservation treatment.
From 1977 to 1992, 1021 women underwent breast-conservation treatment for American Joint Committee on Cancer stage I and II breast cancer at the Hospital of the University of Pennsylvania. In all patients, breast-conservation treatment included complete gross excision of the primary tumor and axillary lymph node dissection, followed by definitive breast irradiation. When indicated, radiation to the regional lymphatics, adjuvant chemotherapy, and/or adjuvant hormones were given. Patients were divided for analysis into three age groups (< or = 40 years, 41 to 50 years, and > or = 51 years) as well as three family history groups (first-degree relative positive for breast cancer, other family history positive for breast cancer, and negative family history for breast cancer). Median follow-up after treatment was 6.1 years.
The 10-year actuarial overall survival rates were 74% for women aged < or = 40 years, 82% for women aged 41 to 50 years, and 82% for women aged > or = 51 years (P = 0.12). For the younger women, aged < or = 40 years, there was a higher 10-year rate of deaths from breast cancer (P = 0.007) but a lower rate of deaths from other causes (P = 0.08) than in the older two age groups. The younger women had a higher rate of local failure at 10 years compared with the two older age groups (22%, 18%, and 12%, respectively), but this difference was not statistically significant (P = 0.10). No significant differences were found between the three family history groups (first-degree relative positive for breast cancer, other family history positive for breast cancer, and negative family history for breast cancer) for survival, freedom from distant metastases, or local failure (all P > or = 0.25). For younger women, aged < or = 40 years, the 5-year outcomes for survival, freedom from distant metastases, and local failure were not different according to family history status (all P > or = 0.18). Similarly, the 5-year outcomes were not different according to family history status for women aged 41 to 50 years (all P > or = 0.46) and for women aged > or = 51 years (all P > or = 0.54).
The present study has confirmed that breast-conservation treatment is suitable for appropriately selected younger patients or patients with a positive family history of breast cancer. Further, a positive family history of breast cancer in younger women does not represent a contraindication to breast-conservation treatment. In summary, younger age, positive family history of breast cancer, or younger age plus a positive family history of breast cancer should not preclude the use of breast-conservation treatment for appropriately selected patients.
本研究报告了患者年龄和家族史对保乳治疗后结局的影响。此外，还研究了年龄与家族史的相互作用，以确定保乳治疗后有乳腺癌家族史阳性（即携带BRCA1或BRCA2基因风险较高）的年轻患者的结局。
1977年至1992年期间，1021名女性在宾夕法尼亚大学医院接受了针对美国癌症联合委员会I期和II期乳腺癌的保乳治疗。所有患者的保乳治疗均包括原发肿瘤的完整大体切除和腋窝淋巴结清扫，随后进行确定性乳腺放疗。必要时，给予区域淋巴结放疗、辅助化疗和/或辅助激素治疗。患者按年龄分为三个组（≤40岁、41至50岁、≥51岁）以及按家族史分为三个组（乳腺癌一级亲属阳性、其他乳腺癌家族史阳性、乳腺癌家族史阴性）进行分析。治疗后的中位随访时间为6.1年。
年龄≤40岁女性的10年精算总生存率为74%，41至50岁女性为82%，≥51岁女性为82%（P = 0.12）。对于年龄≤40岁的年轻女性，乳腺癌导致的10年死亡率较高（P = 0.007），但其他原因导致的死亡率低于两个年龄较大的组（P = 0.08）。与两个年龄较大的组相比，年轻女性10年时的局部复发率较高（分别为22%、18%和12%），但差异无统计学意义（P = 0.10）。在三个家族史组（乳腺癌一级亲属阳性、其他乳腺癌家族史阳性、乳腺癌家族史阴性）之间，生存率、无远处转移生存率或局部复发率均未发现显著差异（所有P≥0.25）。对于年龄≤40岁的年轻女性，根据家族史状态，5年的生存、无远处转移生存率和局部复发率没有差异（所有P≥0.18）。同样，41至50岁女性（所有P≥0.46）和≥51岁女性（所有P≥0.54）根据家族史状态的5年结局也没有差异。
本研究证实，保乳治疗适用于经过适当选择的年轻患者或有乳腺癌家族史阳性的患者。此外，年轻女性有乳腺癌家族史阳性并不代表保乳治疗的禁忌证。总之，年龄较小、有乳腺癌家族史阳性或年龄较小且有乳腺癌家族史阳性，不应排除对经过适当选择的患者使用保乳治疗。
