Early start of adjuvant chemotherapy may improve treatment outcome for premenopausal breast cancer patients with tumors not expressing estrogen receptors
Early start of adjuvant chemotherapy may improve treatment outcome for premenopausal breast cancer patients with tumors not expressing estrogen receptors
复制标题
DOI：
10.1200/jco.2000.18.3.584
复制
发表时间：
2000-02-01
影响因子：
45.3
通讯作者：
Goldhirsch, A
中科院分区：
文献类型：
--
作者：
Colleoni, M;Bonetti, M;Goldhirsch, A
目的：乳腺癌初次手术后开始辅助化疗的适当时间尚不清楚。国际（Ludwig）乳腺癌研究组（IBCSG）试验V中位随访11年的一项分析表明，早期开始辅助化疗可能改善绝经前淋巴结阳性患者的预后，这些患者的肿瘤不表达任何雌激素受体（ER）。我们研究了1,788例绝经前淋巴结阳性患者在IBCSG试验I、II和VI中早期开始辅助化疗、ER状态和预后之间的关系。将599例在20天内开始辅助化疗（早期启动）的患者（84例ER缺失肿瘤）的无病生存期与1，189例在手术后21至86天开始化疗（常规启动）的患者（142例ER缺失肿瘤）的无病生存期进行比较。结果：在ER缺失的肿瘤患者中，早期启动组的10年无病生存率为60%，而常规启动组为34%（226例患者;风险比[HR]，0.49; 95%置信区间[CI]，0.33至0.72; P = 0.0003）。在控制研究组、阳性淋巴结数量、肿瘤大小、年龄、血管浸润和机构的考克斯多元回归分析中，这种差异仍然具有统计学意义（HR，0.60; 95%CI，0.39至0.92; P = 0.019）。相反，早期开始化疗并不能显著改善ER表达肿瘤患者的无病生存率（1,562例患者;多元回归HR，0.93; 95%CI，0.79 - 1.10; P = 0.40）。结论：对于ER缺失的绝经前肿瘤患者，初次手术后早期开始全身化疗可能会改善预后。在对目前的临床实践进行任何广泛的修改之前，需要进行进一步的验证性研究。在绝经前肿瘤患者中，表达一些ER，早期启动的获益不太可能有临床意义。J Clin Oncol 18：584-590. (C)2000年，美国临床肿瘤学会。
purpose: The proper time to commence adjuvant chemotherapy after primary surgery for breast cancer is unknown. An analysis of the International (Ludwig) Breast Cancer Study Group (IBCSG) Trial V at a median follow-up of 11 years suggested that early initiation of adjuvant chemotherapy might improve outcome for premenopausal, node-positive patients whose turners did not express any estrogen receptor (ER).Patients and Methods: We investigated the relationship between early initiation of adjuvant chemotherapy, ER status, and prognosis in 1,788 premenopausal, node-positive patients treated on IBCSG trials I, II, and VI. The disease-free survival for 599 patients (84 with ER-absent tumors) who commenced adjuvant chemotherapy within 20 days (early initiation) was compared with the disease-free survival for 1,189 patients (142 with ER-absent tumors) who started chemotherapy 21 to 86 days after surgery (conventional initiation). The median follow-up was 7.7 years.Results: Among patients with ER-absent tumors, the 10-year disease-free survival was 60% for the early initiation group compared with 34% for the conventional initiation group (226 patients; hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.33 to 0.72; P = .0003). This difference remained statistically significant in a Cox multiple regression analysis controlling for study group, number of positive nodes, tumor size, age, vessel invasion, and institution (HR, 0.60; 95% CI, 0.39 to 0.92; P = .019). Conversely, early initiation of chemotherapy did not significantly improve disease-free survival for patients with tumors expressing ER(1,562 patients; multiple regression HR, 0.93; 95% CI, 0.79 to 1.10; P = .40).Conclusion: In premenopausal patients with ER-absent tumors, early initiation of systemic chemotherapy after primary surgery might improve outcome. Further confirmatory studies are required before any widespread modification of current clinical practice. In premenopausal patients with tumors expressing some ER, gains from early initiation are unlikely to be clinically significant. J Clin Oncol 18:584-590. (C) 2000 by American Society of Clinical Oncology.