Combined-modality treatment for isolated recurrences of breast carcinoma - Update on 30 years of experience at the University of Texas M. D. Anderson Cancer Center and assessment of prognostic factors
Combined-modality treatment for isolated recurrences of breast carcinoma - Update on 30 years of experience at the University of Texas M. D. Anderson Cancer Center and assessment of prognostic factors
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DOI：
10.1002/cncr.21305
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发表时间：
2005-09-15
期刊：
影响因子：
6.2
通讯作者：
Rivera, E
中科院分区：
文献类型：
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作者：
Hanrahan, EO;Broglio, KR;Rivera, E
背景在3项前瞻性、单组研究中，作者先前显示，局部治疗（手术和/或放疗）后接受基于阿霉素的化疗的孤立部位复发性乳腺癌（BC）的蒽环类初治患者结局改善。在本报告中，介绍了既往接受过蒽环类辅助化疗的患者局部治疗后接受多西他赛（100 mg/m2，每21天一次，共6个周期）治疗复发性BC（IV期BC，无临床可测量疾病证据）的11期试验的初步结果，作者提供了3项既往研究的更新。对这些患者的预后因素进行了分析。所有研究的合格标准包括复发性BC的组织学证据，这些复发性BC已被切除和/或放射治疗。使用Kaplan-Meier方法计算生存期。进行单变量生存分析，以检验患者特征与结局之间的相关性（对数秩检验）。考克斯比例风险模型用于确定患者特征和结局之间的多变量相关性。基于紫杉醇的试验（n = 26例患者）的中位随访时间为45个月。这项研究的早期结果是有希望的。中位无病生存期（DFS）为44个月，3年DFS和总生存率（OS）分别为58%和87%。在3项基于多柔比星的研究中，所有存活患者的中位随访时间为121.5个月，估计20年DFS和OS率均为26%。对所有4项研究的患者进行多变量分析，DFS和OS的唯一显著预后因素（P = 0.0006）是初次诊断时累及腋窝淋巴结的数量。一部分孤立性BC复发的患者通过综合治疗实现了延长的DFS。在初步诊断时接受以蒽环类药物为基础的化疗的患者可能受益于局部治疗，然后是以紫杉醇为基础的化疗。唯一有意义的独立预后因素是初次诊断时受累腋窝淋巴结的数量。
BACKGROUND. In three prospective, single-arm studies, the authors previously showed an improved outcome for anthracycline-naive patients with isolated sites of recurrent breast carcinoma (BC) who were treated with doxorubicin-based chemotherapy after local therapy (surgery and/or radiotherapy). In the current report, the initial results are presented from a Phase 11 trial of docetaxel (100 mg/m(2) every 21 days for 6 cycles) given after local therapy for recurrent BC (Stage IV BC with no evidence of clinically measurable disease) in patients who received prior adjuvant anthracycline-based chemotherapy, and the authors provide an update of the 3 previous studies. An analysis of prognostic factors for these patients also is presented.METHODS. Eligibility criteria for all studies included histologic proof of recurrent BC that had been resected and/or irradiated with curative intent. Survival was calculated using the Kaplan-Meier method. Univariate survival analyses were performed to test for associations between patient characteristics and outcome (log-rank test). Cox proportional hazards models were used to determine the multivariable correlations between patient characteristics and outcome.RESULTS. The median follow-up for the docetaxel-based trial (n = 26 patients) was 45 months. Early outcomes for this study are promising. The median disease-free survival (DFS) was 44 months, and the 3-year DFS and overall survival (OS) rates were 58% and 87%, respectively. In the 3 doxorubicin-based studies, the median follow-up was 121.5 months for all living patients, and the estimated 20-year DFS and OS rates were both 26%. On multivariable analysis of patients from all 4 studies, the only significant prognostic factor for DFS and OS (P = 0.0006) was the number of involved axillary lymph nodes at initial diagnosis.CONCLUSIONS. A proportion of patients with isolated BC recurrences achieved prolonged DFS with combined-modality treatment. Patients who receive anthracycline-based chemotherapy at primary diagnosis may benefit from local treatment followed by docetaxel-based chemotherapy for isolated recurrences. The only significant independent prognostic factor was the number of involved axillary lymph nodes at initial diagnosis.