Who should not receive chemotherapy? Data from American databases and trials.
Who should not receive chemotherapy? Data from American databases and trials.
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哪些人不应该接受化疗？
DOI：
10.1093/oxfordjournals.jncimonographs.a003446
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
Krontiras,H
中科院分区：
文献类型：
--
作者：
Morrow,M;Krontiras,H
无论雌激素受体（ER）状态如何，绝经前和绝经后妇女化疗有效性的证明提出了一个问题，即是否所有乳腺癌患者都应该接受化疗。可以确定几个长期预后良好的患者组，他们将从化疗中获得极小的获益。它们包括淋巴结阴性肿瘤大小为1 cm或更小的患者，1级肿瘤大小为1.1 - 2.0 cm的患者，以及良好组织学类型（管状和粘液性）肿瘤大小达3 cm的患者。在接受他莫昔芬治疗的ER阳性、淋巴结阴性的绝经后女性癌症患者亚组中，化疗的获益通常超过风险，这一点尚不清楚。这一组的预后差异很大，化疗应保留给那些复发风险高的患者。最后，70岁及以上的女性化疗没有益处。乳腺癌以外的其他原因造成的高死亡率可能抵消了微小的生存益处，在调整生活质量后，治疗持续时间超过了预期寿命的增加。
The demonstration of the effectiveness of chemotherapy in both premenopausal and postmenopausal women, regardless of estrogen receptor (ER) status, raises the question of whether all breast cancer patients should receive chemotherapy. Several patient groups with such a favorable long-term prognosis that they will obtain an extremely small benefit from chemotherapy can be identified. They include patients with lymph node-negative tumors of 1 cm or less in size, those with grade 1 tumors between 1.1 and 2.0 cm in size, and those with tumors of favorable histologic type (tubular and mucinous) up to 3 cm in size. A patient subgroup in which it is not clear that the benefits of chemotherapy routinely exceed the risks is postmenopausal women with ER-positive, lymph node-negative cancers receiving tamoxifen. There is a wide variation in prognosis in this group, and chemotherapy should be reserved for those at high risk of recurrence. Finally, no benefit for chemotherapy in women aged 70 years and older has been identified. The high rate of death from causes other than breast cancer may negate small survival benefits, and after adjustment for quality of life, the duration of treatment exceeds the gain in life expectancy.