Determinants and prognoses of locoregional and distant progression in breast cancer
Determinants and prognoses of locoregional and distant progression in breast cancer
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DOI：
10.1016/s0360-3016(02)04476-0
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发表时间：
2003-04-01
影响因子：
7
通讯作者：
Hölzel, D
中科院分区：
文献类型：
--
作者：
Engel, J;Eckel, R;Hölzel, D
目的：描述以人群为基础的乳腺癌样本的局部和远处进展。方法和材料：1978年至1998年间，慕尼黑癌症登记处评估了14,429例患者。幸存者的平均随访时间为8.3年。转移（MET）、局部复发（LR）和淋巴结复发（LNR）被视为预后指标。通过Cox和动态Aalen模型对LR和MET的预后因素和影响进行了多变量评估。结果：LR和MET率随肿瘤大小的增加而增加，后者以pT分类描述。远端MET的发生早于局部进展。MET记录的时间甚至更早。MET和LR从诊断到MET的平均时间分别为54.9个月、43.4个月、29.4个月和24.7个月，而仅MET的pT1、pT2、pT3和pT4分别为36.5个月、31.0个月、22.6个月和12.9个月。经MET治疗后，不同pT期患者的生存率差异不大；LR后，预后明显较好，尤其是pT1和pT2。MET后的预后主要取决于MET的位置；50%的脑或神经系统MET患者存活小于1年，50%的骨骼MET患者存活小于2年。在Cox模型中，LR对MET的相对风险为3.0。在Aalen模型中，30个月后，当MET的危险率开始下降时，LR后仍然存在MET的超额风险。结论：这种疾病描述强调了长期观察研究的重要性。已经提供了经验证据，证明LR既是MET的指标，也是MET的部分原因。在未来，MET的位置应该报告。指南或卫生保健系统的差异也应考虑通过不同的诊断程序影响到MET的时间和MET后的生存。(C) 2003爱思唯尔科学有限公司
Purpose: To describe locoregional and distant progression in a population-based breast cancer sample.Methods and Materials: Between 1978 and 1998, the Munich Cancer Registry evaluated 14,429 patients. The mean follow-up of survivors was 8.3 years. Metastases (MET), local recurrence (LR), and lymph node recurrence (LNR) were considered as outcome measures. The prognostic factor for, and effects of, LR and MET were assessed multivariately by the Cox and dynamic Aalen models.Results: The LR and MET rate increased with increasing tumor size, with the latter described by pT category. Distant MET occurred earlier than local progression. MET was recorded even earlier for MET alone. The mean time from diagnosis to MET for MET and LR was 54.9, 43.4, 29.4, and 24.7 months and for MET only was 36.5, 31.0, 22.6, and 12.9 months for pT1, pT2, pT3, and pT4, respectively. After MET, survival varied only slightly by pT stage; after LR, a more favorable prognosis, especially for pT1 and pT2, was evident. The prognosis after MET depended mainly on the MET location; 50 % of patients with cerebral or nervous system MET survived < 1 year and 50% of those with skeletal MET survived >2 years. In the Cox model, the relative risk of LR for MET was 3.0. In the Aalen model, after 30 months, when the hazard rates of MET began to decline, there was still an excess risk of MET after LR.Conclusion: This disease description highlights the importance of long-term observational studies. Empiric evidence that LR is both an indicator for, and in part a cause of, MET has been provided. In the future, the MET location should be reported. Variations in guidelines or health care systems that influence the time to MET and survival after MET through different diagnostic procedures should also be considered. (C) 2003 Elsevier Science Inc.