Identifying breast cancer patients most likely to benefit from aromatase inhibitor therapy after adjuvant radiation and tamoxifen
Identifying breast cancer patients most likely to benefit from aromatase inhibitor therapy after adjuvant radiation and tamoxifen
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DOI：
10.1002/cncr.22291
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发表时间：
2006-12-01
期刊：
影响因子：
6.2
通讯作者：
Goldstein, Lori
中科院分区：
文献类型：
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作者：
Freedman, Gary M.;Anderson, Penny;Goldstein, Lori
背景本研究的目的是检查芳香化酶抑制剂在乳腺癌患者中的选择，这些患者在接受他莫昔芬治疗5年后没有不良事件。总共有471名妇女接受了保乳手术、腋窝淋巴结清扫和放射治疗。入选标准包括T1-2期疾病、使用他莫昔芬、随访≥ 5年、既往无乳腺癌、5年随访时无任何不良事件。与单独使用他莫昔芬治疗的患者相比，接受化疗的患者更常患有T2疾病和淋巴结阳性，并且年龄< 60岁。本研究期间（1982-1999年）没有患者接受芳香酶抑制剂治疗。中位随访时间为8.25年。有36起事件：10例对侧乳腺癌（CBC）和26例复发（8例局部，1例区域和17例远处）。10年局部复发风险为2.5%，10年CBC风险为3.6%，10年远处转移风险为4.4%。所有患者的无事件生存率为93%。多变量分析发现，只有≥ 4个阳性淋巴结和绝经前状态是无事件生存率降低的独立变量。总生存率为89%。只有年龄较小和淋巴结状态较低是提高总生存率的重要预测因素。在目前的研究中，在他莫昔芬治疗5年后加入芳香酶抑制剂，复发/CBC减少40%，边际效益为1%至2%。绝经前妇女和淋巴结阳性>= 4个的患者从扩展治疗中获得的10年无事件生存率绝对获益最大，> 3%。对于年龄≥ 60岁的患者，需要根据其初始淋巴结状态和可能降低其5年预期寿命的合并症的存在进行个体化决策。
BACKGROUND. The purpose of the current study was to examine patient selection for an aromatase inhibitor in breast cancer patients who were free from adverse events 5 years after treatment with tamoxifen.METHODS. In all, 471 women were treated with breast-conserving surgery, axillary lymph node dissection, and radiation. Eligibility included T1-2 disease, tamoxifen use, follow-up of >= 5 years, no prior breast cancer, and freedom from all events at 5 years of follow-up. Patients treated with chemotherapy more often had T2 disease and positive lymph nodes, and were aged < 60 years compared with patients treated with tamoxifen alone. No patient during the period of the current study (1982-1999) received an aromatase inhibitor. The median follow-up was 8.25 years.RESULTS. There were 36 events: 10 contralateral breast cancers (CBCs) and 26 recurrences (8 local, I regional, and 17 distant). The 10-year risk of locoregional recurrence was 2.5%, the 10-year risk of CBC was 3.6%, and the 10-year risk of distant metastasis was 4.4%. The event-free survival rate for all patients was 93%. Only >= 4 positive lymph nodes and premenopausal status were found to be independent variables for decreased event-free survival on multivariate analysis. The overall survival rate was 89%. Only younger age and lower lymph node status were found to be significant predictors of improved overall survival.CONCLUSIONS. In the current study, a 40% reduction in recurrence/CBC with the addition of an aromatase inhibitor after 5 years of tamoxifen treatment would have had a marginal benefit of 1% to 2%. Women who were premenopausal and patients with >= 4 positive lymph nodes would have the greatest absolute benefit of > 3% in the 10-year event-free survival rate from extended therapy. The decision needs to be individualized for patients aged >= 60 years based on their initial lymph node status and the presence of comorbidities that could lower their 5-year life expectancy.