Good clinical response of breast cancers to neoa uvant chemoendocrine therapy is associated with improved overall survival
Good clinical response of breast cancers to neoa uvant chemoendocrine therapy is associated with improved overall survival
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DOI：
10.1093/annonc/mdi049
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发表时间：
2005-02-01
影响因子：
50.5
通讯作者：
Powles, TJ
中科院分区：
文献类型：
--
作者：
Cleator, SJ;Makris, A;Powles, TJ
背景：我们从一项评估新辅助化疗内分泌疗法在可手术乳腺癌治疗中的作用的前瞻性随机试验中进行了扩展的随访。患者和方法：309名妇女随机接受初次手术，然后接受8个周期的米托蒽醌、甲氨蝶呤加他诺昔芬(2MT)或2MT加丝裂霉素C(3MT)，而相同的方案在手术前4个周期，手术后4个周期。中位随访时间为112个月。结果：两组患者的无病生存率(DFS)分别为71%和71%，总生存率(OS)分别为63%和70%，两组间差异无统计学意义(P>0.05)。在接受新辅助治疗的144例可评估患者中，74例临床反应良好，70例临床反应差。与缓解者相比，缓解者的DFS(80%比%，P=0.01)和OS(77%比63%，P=0.03)更好。结论：10年后，新辅助和辅助治疗仍具有相同的OS和DFS。新辅助化疗的良好临床疗效与较好的DFS和OS相关。这支持将乳腺癌对新辅助治疗的临床反应作为生存益处的替代标记物。
Background: We present extended follow-up from a prospective randomised trial evaluating the role of neoadjuvant chemoendocrine therapy in the treatment of operable breast cancer.Patients and methods: 309 women were randomised to primary surgery followed by eight cycles of adjuvant mitoxantrone, methotrexate with tarnoxifen (2MT) or 2MT with mitomycin-C (3MT) versus the same regimen for four cycles before followed by four cycles after surgery. For this analysis the median follow-up of patients was 112 months.Results: After 10 years follow-up there is still no statistically significant difference in disease-free survival (DFS) (71% versus 71%) or overall survival (OS) (63% versus 70%) when comparing adjuvant versus neoadjuvant treatment, respectively. Of 144 evaluable patients in the neoadjuvant arm, 74 achieved a good clinical response and 70 patients achieved a poor clinical response. Good responders had a superior DFS (80% versus 64%, P=0.01) and OS (77% versus 63%, P=0.03) compared to poor responders.Conclusions: At 10 years, neoadjuvant and adjuvant treatment continue to have equivalent OS and DFS. Good clinical response to neoadjuvant chemotherapy is associated with superior DFS and OS. This supports the use of clinical response of primary breast cancer to neoadjuvant therapy as a surrogate marker of survival benefit.