Age, Breast Cancer Subtype Approximation, and Local Recurrence After Breast-Conserving Therapy
Age, Breast Cancer Subtype Approximation, and Local Recurrence After Breast-Conserving Therapy
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DOI：
10.1200/jco.2011.36.1105
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发表时间：
2011-10-10
影响因子：
45.3
通讯作者：
Harris, Jay R.
中科院分区：
文献类型：
--
作者：
Arvold, Nils D.;Taghian, Alphonse G.;Harris, Jay R.
目的：保乳治疗（BCT）的结果显示，年轻乳腺癌（BC）患者的局部复发（LR）率很高，我们研究了1,434例连续的浸润性BC患者，他们从1997年12月至2006年7月接受了BCT。91%的患者接受了辅助全身治疗;没有患者接受曲妥珠单抗治疗。BC的5种亚型大致相同：雌激素受体（ER）或孕激素受体（PR）阳性，HER 2阴性，1 - 2级（即管腔A）; ER阳性或PR阳性，HER 2阴性，3级（即管腔B）; ER或PR阳性，和HER 2阳性（即管腔HER 2）; ER阴性、PR阴性和HER 2阳性（即HER 2）;以及ER阴性、PR阴性和HER 2阴性（即三阴性）。采用Kaplan-Meier法计算LR的精算率。结果中位随访时间为85个月。LR的总体5年累积发生率为2.1%（95% CI，1.4%-3.0%）。5年累积LR发生率为5.0%（95% CI，3.0%-8.3%）年龄四分位数为23 - 46岁; 2.2%（95% CI，1.0%至4.6%）; 55至63岁为0.9%（95% CI，0.3%至2.6%）; 64至88岁为0.6%（95% CI，0.1%至2.2%）。5年累积LR发生率为0.8%（95% CI，0.4%-1.8%）管腔A; 2.3%管腔B（95% CI，0.8%-5.9%）; 1.1%（95% CI，0.2%-7.4%）; 10.8%（95% CI，4.6%-24.4%）;和6.7%（95% CI，3.6%-12.2%）三阴性。多因素分析显示，年龄增加与LR风险降低相关（校正后风险比0.97，95%CI，0.94 ~ 0.99，P = 0.009）。结论在系统治疗和BC分型的时代，年龄仍然是BCT后的独立预后因素。然而，年轻女性LR的风险似乎可以接受的低。
Purpose Prior results of breast-conserving therapy (BCT) have shown substantial rates of local recurrence (LR) in young patients with breast cancer (BC).Patients and Methods We studied 1,434 consecutive patients with invasive BC who received BCT from December 1997 to July 2006. Ninety-one percent received adjuvant systemic therapy; no patients received trastuzumab. Five BC subtypes were approximated: estrogen receptor (ER) or progesterone receptor (PR) positive, HER2 negative, and grades 1 to 2 (ie, luminal A); ER positive or PR positive, HER2 negative, and grade 3 (ie, luminal B); ER or PR positive, and HER2 positive (ie, luminal HER2); ER negative, PR negative, and HER2 positive (ie, HER2); and ER negative, PR negative, and HER2 negative (ie, triple negative). Actuarial rates of LR were calculated by using the Kaplan-Meier method.Results Median follow-up was 85 months. Overall 5-year cumulative incidence of LR was 2.1% (95% CI, 1.4% to 3.0%). The 5-year cumulative incidence of LR was 5.0% (95% CI, 3.0% to 8.3%) for age quartile 23 to 46 years; 2.2% (95% CI, 1.0% to 4.6%) for ages 47 to 54 years; 0.9% (95% CI, 0.3% to 2.6%) for ages 55 to 63 years; and 0.6% (95% CI, 0.1% to 2.2%) for ages 64 to 88 years. The 5-year cumulative incidence of LR was 0.8% (95% CI, 0.4% to 1.8%) for luminal A; 2.3% (95% CI, 0.8% to 5.9%) for luminal B; 1.1% (95% CI, 0.2% 7.4%) for luminal HER2; 10.8% (95% CI, 4.6% to 24.4%) for HER2; and 6.7% (95% CI, 3.6% to 12.2%) for triple negative. On multivariable analysis, increasing age was associated with decreased risk of LR (adjusted hazard ratio, 0.97; 95% CI, 0.94 to 0.99; P = .009).Conclusion In the era of systemic therapy and BC subtyping, age remains an independent prognostic factor after BCT. However, the risk of LR for young women appears acceptably low.