Breast cancer phenotype, nodal status and palpability may be useful in the detection of overdiagnosed screening-detected breast cancers
Breast cancer phenotype, nodal status and palpability may be useful in the detection of overdiagnosed screening-detected breast cancers
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DOI：
10.1093/annonc/mdt179
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发表时间：
2013-07-01
影响因子：
50.5
通讯作者：
Neven, P.
中科院分区：
文献类型：
--
作者：
Brouckaert, O.;Schoneveld, A.;Neven, P.
背景：乳腺癌仍然是女性癌症死亡的主要原因，尽管治疗和筛查有所改善。筛查经常因导致过度诊断和过度治疗而受到批评。然而，很少有人试图确定过度诊断cases.Patients和方法：一个大的，连续的一系列患者治疗的主要可操作的，筛查检测，乳腺癌（n = 1610）。病理学和临床报告、治疗和随访的详细信息可从我们前瞻性管理的数据库中获得。单变量和多变量考克斯比例模型被用来研究在筛查检测到的乳腺癌的远处转移和乳腺癌特异性survival.Results的预后变量：我们包括1610例患者。平均/中位随访时间为6.0/6.0年。单变量分析：肿瘤大小、可触知性、乳腺癌表型和淋巴结状态是远处转移和乳腺癌特异性死亡的预测因子。多因素分析：触诊，乳腺癌表型和淋巴结状态仍然是独立的预后变量。触诊不同的乳腺癌phenotype.Conclusion：筛查检测乳腺癌是与优秀的结果。触诊、淋巴结状态和乳腺癌表型是独立的预后变量，可能选择远处转移复发和乳腺癌特异性死亡风险增加的患者。过度诊断的病例最有可能存在于具有管腔A表型的不可触及淋巴结阴性亚组中。
Background: Breast cancer remains the leading cause of female cancer death despite improvements in treatment and screening. Screening is often criticized for leading to overdiagnosis and overtreatment. However, few have attempted to identify overdiagnosed cases.Patients and methods: A large, consecutive series of patients treated for primary operable, screening-detected, breast cancer (n = 1610). Details from pathology and clinical reports, treatment and follow-up were available from our prospectively managed database. Univariate and multivariate Cox proportional models were used to study the prognostic variables in screening-detected breast cancers for distant metastatic and breast cancer-specific survival.Results: We included 1610 patients. The mean/median follow-up was 6.0/6.0 years. Univariate analysis: tumor size, palpability, breast cancer phenotype and nodal status were predictors of distant metastasis and breast cancer-specific death. Multivariate analysis: palpability, breast cancer phenotype and nodal status remained independent prognostic variables. Palpability differed by breast cancer phenotype.Conclusion: Screening-detected breast cancer is associated with excellent outcome. Palpability, nodal status and breast cancer phenotype are independent prognostic variables that may select patients at increased risk for distant metastatic relapse and breast cancer-specific death. Overdiagnosed cases reside most likely in the nonpalpable node negative subgroup with a Luminal A phenotype.