Effect of preoperative chemotherapy on the outcome of women with operable breast cancer
Effect of preoperative chemotherapy on the outcome of women with operable breast cancer
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DOI：
10.1200/jco.1998.16.8.2672
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发表时间：
1998-08-01
影响因子：
45.3
通讯作者：
Bear, HD
中科院分区：
文献类型：
--
作者：
Fisher, B;Bryant, J;Bear, HD
目的：确定原发性可手术乳腺癌的女性，如果术前阿霉素（Adrimycin）和环磷酰胺（Cytoxan：AC）治疗会比术后AC疗法的结果更好这种疗法会导致更多的肿块切除术的性能。患者和方法：女性（1,523）招募到国家手术辅助乳房和排便项目（NSABP）B-18被随机分配给术前或术后AC疗法。对术前治疗的临床肿瘤反应分级为完整（CCR），部分（CPR）或无反应（CNR）。具有CCR的肿瘤进一步归类为病理完全反应（PCR）或浸润细胞（PINV）。估计无病生存期（DFS），无病生存率（DDF）和5年的生存率，并在治疗组之间进行了比较。在术前的臂中，使用比例危害模型来研究结果与肿瘤反应之间的关系。分子：DFS，DDFS或存活率没有显着差异（分别为p = .99，.70和.83）在两组中的患者中。术前治疗的患者多于术后接受肿瘤切除术和放射治疗（分别为67.8％V 59.8％）。两组的同侧乳腺肿瘤复发率（IBTR）相似（分别为7.9％和5.8％； p = .23）。在肿瘤表现出PCR的女性中，结果比患有PINV，CPR或CNR的女性（无复发生存率[RFS]率，85.7％，76.9％，68.1％和63.9％； P <.0001分别； ），即使控制基线预后变量。当比较每个治疗组的预后模型时，术前模型包括乳腺肿瘤反应是一种可变的，歧视性的结果，与术后模型的程度大致相同。结论：术前化学疗法与术后化疗一样有效，允许更多肿块切除术适用于某些患有I阶段I和II疾病的患者，可用于研究乳腺癌生物学。肿瘤对术前化疗的反应与预后相关，可能是评估化学疗法对微转移酶的影响的替代物。但是，这种反应的知识几乎没有术后治疗所产生的预后信息。 J Clin Oncol 16：2672-2685。 （c）1998年美国临床肿瘤学会。
Purpose: To determine, in women with primary operable breast cancer, if preoperative doxorubicin (Adriamycin) and cyclophasphamide (Cytoxan: AC) therapy yields a better outcome than postoperative AC therapy if a relationship exists between outcome and tumor response to preoperative chemotherapy, and if such therapy results in the performance of more lumpectomies.Patients and Methods: Women (1,523) enrolled onto National Surgical Adjuvant Breast and Bowel Project (NSABP) B-18 were randomly assigned to preoperative or postoperative AC therapy. Clinical tumor response to preoperative therapy was graded as complete (cCR), partial (cPR), or no response (cNR). Tumors with a cCR were further categorized as either pathologic complete response (pCR) or invasive cells (pINV). Disease-free survival (DFS), distant disease-free survival (DDFS), and survival were estimated through 5 years and compared between treatment groups. In the preoperative arm, proportional-hazards models were used to investigate the relationship between outcome and tumor response.Results: There was no significant difference in DFS, DDFS, or survival (P = .99, .70, and .83, respectively) among patients in either group. More patients treated preoperatively than postoperatively underwent lumpectomy and radiation therapy (67.8% v 59.8%, respectively). Rates of ipsilateral breast tumor recurrence (IBTR) after lumpectomy were similar in both groups (7.9% and 5.8%, respectively; P = .23). Outcome was better in women whose tumors showed a pCR than in those with a pINV, cPR, or cNR (relapse-free survival [RFS] rates, 85.7%, 76.9%, 68.1%, and 63.9%, respectively; P < .0001), even when baseline prognostic variables were controlled. When prognostic models were compared for each treatment group, the preoperative model, which included breast tumor response as a variable, discriminated outcome among patients to about the same degree as the postoperative model.Conclusion: Preoperative chemotherapy is as effective as postoperative chemotherapy, permits more lumpectomies, is appropriate for the treatment of, certain patients with stages I and II disease, and can be used to study breast cancer biology. Tumor response to preoperative chemotherapy correlates with outcome and could be a surrogate for evaluating the effect of chemotherapy on micrometastases; however, knowledge of such a response provided little prognostic information beyond that which resulted from postoperative therapy. J Clin Oncol 16: 2672-2685. (C) 1998 by American Society of Clinical Oncology.