Prolonged disease-free survival after one course of perioperative adjuvant chemotherapy for node-negative breast cancer.
Prolonged disease-free survival after one course of perioperative adjuvant chemotherapy for node-negative breast cancer.
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淋巴结阴性乳腺癌围手术期辅助化疗一个疗程后无病生存期延长。
DOI：
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发表时间：
1989
影响因子：
158.5
通讯作者：
J. Probert
中科院分区：
文献类型：
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作者：
A. Goldhirsch;B. Davis;R. Bettelheim;Hartmann Wh;M. Neville;M. Castiglione;A. Pedrazzini;Zava Dt;C. Wiedmer;R. Gelber;Price Kn;K. Stanley;N. Snudden;M. Zelen;M. Isley;M. Parsons;L. Szymoniak;R. Kay;J. Probert
我们在一项随机试验（Ludwig试验V）中比较了一个辅助联合化疗的围手术期周期与无辅助治疗的围手术期周期，该试验包括1275例无腋窝淋巴结转移的乳腺癌患者。在乳房切除术后36小时内开始，在第1天和第8天进行化疗，化疗药物包括环磷酰胺、甲氨蝶呤、氟尿嘧啶和亚叶酸。在中位随访42个月时，接受围手术期化疗的患者的平均4年无病生存率（+/- SE）为77 +/-2%，而未接受辅助治疗的患者为73 +/-2%（风险比，0.77; 95%置信区间，0.61至0.98; P = 0.04）。绝经前和绝经后妇女均观察到优势。在原发肿瘤中没有或低雌激素受体含量的患者中，治疗效果的幅度最大。我们得出结论，化疗修改淋巴结阴性乳腺癌的术后病程。进一步研究患者和治疗的最佳选择的试验应被视为最佳的治疗方法。
We compared a single perioperative cycle of adjuvant combination chemotherapy with no adjuvant treatment in a randomized trial (Ludwig Trial V) including 1275 patients with breast cancer who had no axillary-node metastases. The chemotherapy was administered on days 1 and 8, beginning within 36 hours after mastectomy, and consisted of cyclophosphamide, methotrexate, fluorouracil, and leucovorin. At a median follow-up of 42 months, the mean four-year disease-free survival (+/- SE) was 77 +/- 2 percent among the patients who received chemotherapy perioperatively, as compared with 73 +/- 2 percent among the patients who received no adjuvant treatment (hazard ratio, 0.77; 95 percent confidence interval, 0.61 to 0.98; P = 0.04). An advantage was observed for both premenopausal and postmenopausal women. The magnitude of the treatment effect was largest among patients with no or low estrogen-receptor content in the primary tumor. We conclude that chemotherapy modifies the post-operative course of node-negative breast cancer. Further trials to investigate an optimal selection of patients and treatments should be regarded as the best available therapeutic approach.