Natural history of more than 20 years of node-positive primary breast carcinoma treated with cyclophosphamide, methotrexate, and fluorouracil-based adjuvant chemotherapy: A study by the Cancer and Leukemia Group B
Natural history of more than 20 years of node-positive primary breast carcinoma treated with cyclophosphamide, methotrexate, and fluorouracil-based adjuvant chemotherapy: A study by the Cancer and Leukemia Group B
复制标题
DOI：
10.1200/jco.2003.09.006
复制
发表时间：
2003-05-01
影响因子：
45.3
通讯作者：
Norton, L
中科院分区：
文献类型：
--
作者：
Weiss, RB;Woolf, SH;Norton, L
目的：乳腺癌的异质性要求进行长时间的随访以评估结果。本文介绍了基于环磷酰胺、甲氨蝶呤和氟尿嘧啶 (CMF) 辅助治疗的三种治疗方案的疗效差异，但强调了癌症复发部位、复发时间、随后的原发癌症以及淋巴结阳性乳腺癌自然史中的死亡原因。 患者和方法：从 1975 年开始，随机对 905 名淋巴结阳性癌症患者进行研究 分配接受 CMF 或两种 CMF 加其他药物治疗方案。中位随访时间为 22.6 年。对 814 名患者的子集进行了自然历史分析。结果：已知死亡的 599 名女性中，80% 死于转移性乳腺癌。只有 8.5% 的女性死亡者死于乳腺癌、第二或第三种癌症或辅助化疗毒性以外的原因。 105 名女性 (12.8%) 患有其他原发性癌症，其中 49 名 (46.6%) 发生在对侧乳房。早先报道的CMF方案的疗效差异在20多年后仍保持不变。对于某些子集，五种药物方案比 CMF 更有优势。骨是最常见的复发部位。最长的复发间隔为 23.5 年，其中 18% 的复发者在 10 多年后复发。结论：尽管进行了辅助化疗，绝大多数（80%）患有淋巴结阳性乳腺癌的女性仍死于该疾病，并且许多复发是在 10 多年后发生的。与 CMF 相比，CMF 加长春新碱和泼尼松具有一定的益处，但其程度随涉及节点的数量而变化。这项研究早期分析的结果趋势甚至在几年后仍然得以维持。 (C) 2003 年，美国临床肿瘤学会。
Purpose : Breast cancer heterogeneity dictates lengthy follow-up to assess outcomes. Efficacy differences for three regimens that are based on adjuvant cyclophosphamide, methotrexate, and fluorouracil (CMF) are presented in this article, but cancer recurrence sites, time of relapse, subsequent primary cancers, and causes of death in the natural history of node-positive breast cancer are emphasized.Patients and Methods: Beginning in 1975, 905 patients with node-positive cancer were randomly assigned to receive CMF or two regimens of CMF plus other agents. Median follow-up is 22.6 years. The natural-history analysis was performed on a subset of 814 patients.Results : Eighty percent of the 599 women known to have died, died of metastatic breast cancer. Only 8.5% of the deceased women died of a cause other than breast cancer, a second or third cancer, or adjuvant chemotherapy toxicity. One hundred five women (12.8%) developed other primary cancers, with 49 (46.6%) occurring in the contralateral breast. Therapeutic efficacy differences of the CMF regimens reported earlier have been maintained more than 20 years later. For certain subsets, the five-drug regimen had advantages over CMF. Bone was the most common recurrence site. The longest interval to relapse has been 23.5 years, and 18% of those who relapsed did so more than 10 years later.Conclusion: Despite adjuvant chemotherapy, a large majority (80%) of women with node-positive breast cancer die of the disease, and many recurrences develop more than 10 years later. CMF plus vincristine and prednisone provides a benefit compared with CMF, but the magnitude varies with the number of involved nodes. Outcome trends in earlier analyses of this study were maintained even years later. (C) 2003 by American Society of Clinical Oncology.