Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: Experience of the Eastern Cooperative Oncology Group
Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: Experience of the Eastern Cooperative Oncology Group
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DOI：
10.1200/jco.1999.17.6.1689
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发表时间：
1999-06-01
影响因子：
45.3
通讯作者：
Tormey, DC
中科院分区：
文献类型：
--
作者：
Recht, A;Gray, R;Tormey, DC
目的：评估乳腺癌患者切除腋窝淋巴结后失败的模式以及选择的预后和治疗因素对局部区域失败(LRF)风险的影响。患者和方法：研究对象包括参加由东方合作肿瘤学小组进行的4个随机试验的2,016名患者。无复发患者的中位随访时间为12.1年(0.07年至19.1年)。结果：共有1,099名患者(55%)经历了疾病复发。首位失效部位：孤立性LE 254例(13%)，LRF合并远距衰竭166例(8%)，单纯远距LRF 679例(34%)。在有或没有同时发生DF的10年内，有1~3个阳性结节的患者发生LRF的风险为12.9%，有4个或更多阳性结节的患者发生LRF的风险为28.7%。多因素分析显示，肿瘤体积增大、受累结节数目增加、雌激素受体蛋白状态阴性、结节数目减少是增加乳癌根治术后合并或不合并DF的发生率的显著因素。结论：乳癌根治术后LRF是一个严重的临床问题，尽管使用或不联合他莫昔芬化疗，仍需进行前瞻性随机试验，以准确估计乳腺癌术后放射治疗的潜在无病和总体生存效益，特别是那些接受当前和未来系统治疗方案治疗的预后亚组。(C)1999年，由美国临床肿瘤学会主办。
Purpose: To assess patterns of failure and how selected prognostic and treatment factors affect the risks of locoregional failure (LRF) after mastectomy in breast cancer patients with histologically involved axillary nodes treated with chemotherapy with or without tamoxifen without irradiation.Patients and Methods: The study population consisted of 2,016 patients entered onto four randomized trials conducted by the Eastern Cooperative Oncology Group. The median follow-up time far patients without recurrence was 12.1 years (range, 0.07 to 19.1 years).Results: A total of 1,099 patients (55%) experienced disease recurrence. The first sites of failure were as follows: isolated LEE, 254(13%); LRF with simultaneous distant failure (DF), 166 (8%); and distant only, 679 (34%). The risk of LRF with or without simultaneous DF at 10 years was 12.9% in patients with one to three positive nodes and 28.7% for patients with four or more positive nodes. Multivariate analysis showed that increasing tumor size, increasing numbers of involved nodes, negative estrogen receptor protein status, and decreasing number of nodes examined were significant for increasing the rate of LRF with or without simultaneous DF,Conclusion: LRF after mastectomy is a substantial clinical problem, despite the use of chemotherapy with or without tamoxifen, prospective randomized trials will be necessary to estimate accurately the potential disease-free and overall survival benefits of postmastectomy radiotherapy for patients in particular prognostic subgroups treated with presently used and future systemic therapy regimens. (C) 1999 by American Society of Clinical Oncology.