Predictors of local-regional recurrence after neoadjuvant chemotherapy and mastectomy without radiation
Predictors of local-regional recurrence after neoadjuvant chemotherapy and mastectomy without radiation
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DOI：
10.1200/jco.20.1.17
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发表时间：
2002-01-01
影响因子：
45.3
通讯作者：
Hortobagyi, GN
中科院分区：
文献类型：
--
作者：
Buchholz, TA;Tucker, SL;Hortobagyi, GN
目的：为了确定局部区域复发（LRR）的临床和病理预测与新辅助化疗和乳房切除术治疗的患者没有radiation.Patients和方法：我们分析了150例乳腺癌病例治疗的前瞻性机构试验与新辅助化疗和乳房切除术没有乳房切除术后放疗的结果。诊断时的临床分期为I期1%，II期43%，IIIA期23%，IIIB期25%，IV期7%。结果：存活患者的中位随访时间为4.1年。5年和10年的LRR精算率均为27%。与LRR呈正相关的治疗前因素是T分期增加（P < .0001）和联合临床分期增加（P < .0001）。与LRR呈正相关的病理学和治疗因素是残留原发肿瘤的大小（P = 0.0048），受累淋巴结数量的增加（P <0.0001），以及未使用他莫昔芬（P = 0.0013）。18例原发肿瘤和淋巴结病理完全缓解（pCR）患者的LRR率为19%（95%置信区间，6%至48%）。在前向逐步考克斯逻辑回归分析中，临床分期IIIB或更高（风险比为4.5，P <0.001），病理累及4个或更多淋巴结（风险比为2.7，P = 0.008），未使用他莫昔芬（风险比为3.9，P = 0.027）独立预测LRR。晚期疾病和化疗后淋巴结阳性预测临床显著的LRR率。如果疾病的预处理阶段需要，则实现pCR并不排除乳房切除术后放疗的需要。(C)2001年，美国临床肿瘤学会。
Purpose: To define clinical and pathologic predictors of local-regional recurrence (LRR) for patients treated with neoadjuvant chemotherapy and mastectomy without radiation.Patients and Methods: We analyzed the outcome of the 150 breast cancer cases treated on prospective institutional trials with neoadjuvant chemotherapy and mastectomy without postmastectomy radiation. Clinical stage at diagnosis was I in 1%, II in 43%, IIIA in 23%, IIIB in 25%, and IV in 7%. No patient had inflammatory breast cancer.Results: The median follow-up period of surviving patients was 4.1 years. The 5- and 10-year actuarial rates of LRR were both 27%. Pretreatment factors that positively correlated with LRR were increasing T stage (P < .0001) and increasing combined clinical stage (P < .0001). Pathologic and treatment factors that positively correlated with LRR were size of the residual primary tumor (P = .0048), increasing number of involved lymph nodes (P < .0001), and no use of tamoxifen (P = .0013). The LRR rate for the 18 patients with a pathologic complete response of both the primary tumor and lymph nodes (pCR) was 19% (95% confidence interval, 6% to 48%). In a forward stepwise Cox logistic regression analysis, clinical stage IIIB or greater (hazard ratio of 4.5, P < .001), pathologic involvement of four or more lymph nodes (hazard ratio of 2.7, P = .008), and no use of tamoxifen (hazard ratio of 3.9, P = .027) independently predicted for LRR.Conclusion: Advanced disease at presentation and positive lymph nodes after chemotherapy predict for clinically significant rates of LRR. Achievement of pCR does not preclude the need for postmastectomy radiation if warranted by the pretreatment stage of the disease. (C) 2001 by American Society of Clinical Oncology.