Hazard of recurrence and adjuvant treatment effects over time in lymph node-negative breast cancer.
Hazard of recurrence and adjuvant treatment effects over time in lymph node-negative breast cancer.
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DOI：
10.1007/s10549-008-0200-5
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发表时间：
2009-08
影响因子：
3.8
通讯作者：
Wolmark, Norman
中科院分区：
文献类型：
--
作者：
Dignam, James J.;Dukic, Vanja;Anderson, Stewart J.;Mamounas, Eleftherios P.;Wickerham, D. Lawrence;Wolmark, Norman
对于腋窝淋巴结阴性乳腺癌患者，辅助治疗的获益小于淋巴结阳性乳腺癌患者，因此需要更有选择性地使用，从而促进风险分析的发展，以确定最有可能受益的患者。检查淋巴结阴性乳腺癌失败风险随时间的大小和变化也可能在这方面提供信息。在来自五项研究化疗和他莫昔芬治疗淋巴结阴性乳腺癌的随机试验（1982-1998 年应计）的 9,444 名参与者中，我们通过肿瘤雌激素受体 (ER) 状态和辅助治疗来估计随时间推移的复发风险。在仅接受手术治疗的患者中，我们观察到先前提到的较大风险峰值，随后 ER 阴性患者的风险迅速下降，而 ER 阳性患者的风险较小但更持久。大约 48 个月后，ER 阳性的风险更大。对于辅助治疗，虽然他莫昔芬将 ER 阳性患者的早期风险降低到化疗治疗的 ER 阴性组的早期风险，但在后期随访（5 年以上）中，ER 阳性患者的风险再次超过 ER 阴性患者。在 ER 阳性患者中添加化疗到他莫昔芬会导致早期风险大幅降低，但在后期随访中，风险与仅接受手术或他莫昔芬治疗的患者的风险一致。随着时间的推移，复发危险揭示了可能与生物和治疗策略相关的风险变化。在 ER 阴性肿瘤中，早期化疗带来巨大益处，但随着时间的推移，复发风险始终较低。在 ER 阳性患者中，化疗的益处似乎主要集中在早期随访中，并且仍然存在较大的复发风险。
For patients with axillary lymph node-negative breast cancer, benefits from adjuvant therapy are smaller than in node-positive disease and thus more selective use is warranted, prompting development of risk profiling to identify those most likely to benefit. Examination of the magnitude and changes in the hazard of failure over time in node-negative breast cancer may also be informative in this regard. Among 9,444 participants from five randomized trials (accrual 1982–1998) investigating chemotherapy and tamoxifen for node-negative breast cancer, we estimated recurrence hazards over time by tumor estrogen receptor (ER) status and adjuvant treatment. In patients treated by surgery only, we observed the previously noted larger hazard peak followed by a rapid decrease in ER-negative patients and smaller but more persistent hazard in ER-positive patients. After approximately 48 months, the ER-positive hazard is greater. For adjuvant treatment, while tamoxifen decreases the early hazard in ER-positive patients to that of the chemotherapy-treated ER-negative group, in later follow-up (beyond 5 years) the hazard for ER-positive patients again exceeds that of ER-negative patients. Adding chemotherapy to tamoxifen in ER-positive patients results in large early hazard reduction, but in later follow-up the hazard converges with those of patients treated by surgery only or tamoxifen. Recurrence hazards over time reveal changes in risk that may have biologic and therapeutic strategy relevance. In ER-negative tumors, a large early chemotherapy benefit is followed by a consistently low recurrence hazard over time. In ER-positive patients, the chemotherapy benefit appears concentrated mostly in earlier follow-up, and a greater recurrence risk remains.
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影响因子：
8.8
作者：
Demicheli, R;Valagussa, P;Bonadonna, G
通讯作者：
Bonadonna, G
影响因子：
3.8
作者：
Hess, KR;Pusztai, L;Hortobagyi, GN
通讯作者：
Hortobagyi, GN
影响因子：
45.3
作者：
Fisher, B;Anderson, S;Farrar, WB
通讯作者：
Farrar, WB
影响因子：
158.5
作者：
FISHER, B;REDMOND, C;CAPLAN, R
通讯作者：
CAPLAN, R
影响因子：
3.8
作者：
Anderson, William F.;Chen, Bingshu E.;Rosenberg, Philip S.
通讯作者：
Rosenberg, Philip S.