Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five national surgical adjuvant breast and bowel project node-positive adjuvant breast cancer trials
Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five national surgical adjuvant breast and bowel project node-positive adjuvant breast cancer trials
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DOI：
10.1200/jco.2005.04.3273
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发表时间：
2006-05-01
影响因子：
45.3
通讯作者：
Wolmark, N
中科院分区：
文献类型：
--
作者：
Wapnir, IL;Anderson, SJ;Wolmark, N
目的保乳手术后局部失败与远处疾病和死亡的风险增加有关。接受化疗的患者的这种风险的大小还没有得到充分的characteristic.Patients和方法我们的研究人群包括2,669名妇女随机分配到五个国家外科辅助乳腺和肠道项目淋巴结阳性协议（B-15，B-16，B-18，B-22，和B-25），谁是乳房肿瘤切除术，全乳放疗和辅助全身治疗。计算同侧乳腺肿瘤复发（IBTR）和其他局部复发（oLRR）的累积发生率。Kaplan-Meier曲线用于估计IBTR或oLRR后的无远距离疾病生存期（DDFS）和总生存期（OS）。使用临床和病理因素以及IBTR或oLRR作为时变预测因素，使用考克斯模型对生存进行建模。结果424例患者（15.9%）出现局部失败; 259例（9.7%）出现IBTR，165例（6.2%）出现oLRR。IBTR和oLRR的10年累积发生率分别为8.7%和6.0%。大多数局部失败发生在5年内（IBTR为62.2%，oLRR为80.6%）。年龄、肿瘤大小和雌激素受体状态与IBTR显著相关。淋巴结状态、雌激素和孕激素受体状态与oLRR显著相关。IBTR和oLRR后的5年DDFS率分别为51.4%和18.8%。IBTR和oLRR后的5年OS率分别为59.9%和24.1%。与IBTR和oLRR相关的死亡风险比分别为2.58（95%CI，2.11 ~ 3.15）和5.85（95%CI，4.80 ~ 7.13）。
Purpose Locoregional failure after breast-conserving surgery is associated with increased risk of distant disease and death. The magnitude of this risk in patients receiving chemotherapy has not been adequately characterized.Patients and Methods Our study population included 2,669 women randomly assigned onto five National Surgical Adjuvant Breast and Bowel Project node-positive protocols (B-15, B-16, B-18, B-22, and B-25), who were treated with lumpectomy, whole-breast irradiation, and adjuvant systemic therapy. Cumulative incidences of ipsilateral breast tumor recurrence (IBTR) and other locoregional recurrence (oLRR) were calculated. Kaplan-Meier curves were used to estimate distant-disease-free survival (DDFS) and overall survival (OS) after IBTR or oLRR. Cox models were used to model survival using clinical and pathologic factors jointly with IBTR or oLRR as time-varying predictors.Results Four hundred twenty-four patients (15.9%) experienced locoregional failure; 259 (9.7%) experienced IBTR, and 165 (6.2%) experienced oLRR. The 10-year cumulative incidence of IBTR and oLRR was 8.7% and 6.0%, respectively. Most locoregional failures occurred within 5 years (62.2% for IBTR and 80.6% for oLRR). Age, tumor size, and estrogen receptor status were significantly associated with IBTR. Nodal status and estrogen and progesterone receptor status were significantly associated with oLRR. The 5-year DDFS rates after IBTR and oLRR were 51.4% and 18.8%, respectively. The 5-year OS rates after IBTR and oLRR were 59.9% and 24.1%, respectively. Hazard ratios for mortality associated with IBTR and oLRR were 2.58 (95% CI, 2.11 to 3.15) and 5.85 (95% CI, 4.80 to 7.13), respectively.Conclusion Node-positive breast cancer patients who developed IBTR or oLRR had significantly poorer prognoses than patients who did not experience these events.