Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: Findings from National Surgical Adjuvant Breast and Bowel Project B-18
Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: Findings from National Surgical Adjuvant Breast and Bowel Project B-18
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DOI：
10.1200/jco.1997.15.7.2483
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发表时间：
1997-07-01
影响因子：
45.3
通讯作者：
Dimitrov, NV
中科院分区：
文献类型：
--
作者：
Fisher, B;Brown, A;Dimitrov, NV
目的：确定术前阿霉素和环磷酰胺 (AC) 是否允许进行更多的肿块切除术并降低原发性乳腺癌女性阳性淋巴结的发生率。 患者和方法：女性 (n = 1,523) 被随机分配至国家乳腺和肠道辅助手术项目 (NSABP) B-18； 759 名符合条件的患者接受术后 AC 治疗，747 名患者接受术前 AC 治疗，在四个 AC 周期的每个周期之前和手术前确定乳腺和腋窝肿瘤的临床大小，肿瘤对术前治疗的反应为临床完全 (cCR)、部分 (cPR)、稳定 (cSD) 或疾病进展 (cPD)。对 cCR 患者的组织进行病理学完全缓解 (pCR) 评估。结果：术前治疗后，80% 的患者乳腺肿瘤尺寸缩小； 36% 达到 cCR。肿瘤大小和临床淋巴结状态是 cCR 的独立预测因素，26% 的 cCR 女性获得了 pCR。 89% 的淋巴结阳性患者出现临床淋巴结反应：73% 的患者获得 cCR，其中 44% 的患者获得 pCR，病理阴性淋巴结的发生率增加了 37%。在随机分组之前，建议对肿瘤小于或等于 2 cm 的女性 86%、肿瘤 2.1 至 5.0 cm 的女性 70%、肿瘤大于或等于 5.1 cm 的女性 3% 进行肿瘤切除术。临床肿瘤大小和淋巴结状态影响了医生的决定，总体而言，术前组进行的肿块切除术多了 12%；在肿瘤大于或等于5.1厘米的女性中，增加了175%。结论：术前治疗缩小了大多数乳腺肿瘤的大小，并降低了阳性淋巴结的发生率。术前治疗后肿块切除术增加最多的是肿瘤大于或等于 5 厘米的女性，因为肿瘤小于 5 厘米的女性已经是肿块切除术的候选者，对于判断为肿块切除术过大的乳房肿块，应考虑术前治疗进行初步处理。 (C) 1997 年，美国临床肿瘤学会。
Purpose: To determine whether preoperative doxorubicin and cyclophosphamide (AC) permits more lumpectomies to be performed and decreases the incidence of positive nodes in women with primary breast cancer.Patients and Methods: Women (n = 1,523) were randomized to National Surgical Adjuvant Breast and Bowel Project (NSABP) B-18; 759 eligible patients received postoperative AC and 747, preoperative AC, The clinical size of breast and axillary tumors was determined before each of four cycles of AC and before surgery, Tumor response to preoperative therapy was clinically complete (cCR), partial (cPR), stable (cSD), or progressive disease (cPD). Tissue from patients with a cCR was evaluated for a pathologic complete response (pCR).Results: Breast tumor size was reduced in 80% of patients after preoperative therapy; 36% had a cCR. Tumor size and clinical nodal status were independent predictors of cCR, Twenty-six percent of women with a cCR had a pCR. Clinical nodal response occurred in 89% of node-positive patients: 73% had a cCR and 44% of those had a pCR, There was a 37% increase in the incidence of pathologically negative nodes. Before randomization, lumpectomy was proposed for 86% of women with tumors less than or equal to 2 cm, 70% with tumors 2.1 to 5.0 cm, and 3% with tumors greater than or equal to 5.1 cm. Clinical tumor size and nodal status influenced the physician's decision, Overall, 12% more lumpectomies were performed in the preoperative group; in women with tumors greater than or equal to 5.1 cm, there was a 175% increase.Conclusion: Preoperative therapy reduced the size of most breast tumors and decreased the incidence of positive nodes. The greatest increase in lumpectomy after preoperative therapy occurred in women with tumors greater than or equal to 5 cm, since women with tumors less than 5 cm were already lumpectomy candidates, Preoperative therapy should be considered for the initial management of breast rumors judged too large for lumpectomy. (C) 1997 by American Society of Clinical Oncology.