临床肿瘤杂志新文章:关于淋巴阴性,HER2阳性的乳癌治疗

6月2日临床肿瘤杂志（JCO，Journal of Clinical Oncology）发表的新文章里分析了16,975名乳腺癌患者，如乳癌小于5mm，淋巴阴性，T1a分期的，HER2阳性的，术后不化疗，五年内远端侵袭性复发的风险相当地小。无侵袭性远端复发率（DRFI，distant-recurrence-free-interval）可高达99%，提示这种患者也许化疗是不必要的。治疗前请根据自己的情况与医生仔细探讨。

来源: http://jco.ascopubs.org/content/early/2014/06/02/JCO.2013.52.0858.abstract

Distant Invasive Breast Cancer Recurrence Risk in Human Epidermal Growth Factor Receptor 2–Positive T1a and T1b Node-Negative Localized Breast Cancer Diagnosed From 2000 to 2006: A Cohort From an Integrated Health Care Delivery System

1. Louis Fehrenbacher⇑,
2. Angela M. Capra,
3. Charles P. Quesenberry Jr,
4. Regan Fulton,
5. Parveen Shiraz and
6. Laurel A. Habel

 Author Affiliations

1. Corresponding author: Louis Fehrenbacher, MD, Oncology Department, Vallejo Medical Center, Kaiser Permanente, 975 Sereno Dr, Vallejo, CA 94589; e-mail: [e-mail].

Abstract

Purpose To determine the invasive recurrence (IR) risk among patients with small, node-negative human epidermal growth factor receptor 2 (HER2) –positive breast cancer.

Patients and Methods Among 16,975 consecutive patients with invasive breast cancer diagnosed from January 1, 2000, to December 31, 2006, in a large, integrated health care system, we identified a cohort of 234 patients with HER2-positive T1aN0M0 or T1bN0M0 (T1abN0M0) disease with a median follow-up of 5.8 years. Kaplan-Meier methods were used to estimate the percentage of patients who were free of invasive recurrence (recurrence-free interval [RFI]) at 5 years for both distant (DRFI) and local (LRFI) recurrences.

Results Of 15 IRs, 47% were locoregional only. Among T1ab patients not treated with adjuvant trastuzumab or chemotherapy (n = 171), the 5-year invasive DRFI was 98.2% (95% CI, 94.5% to 99.4%); it was 99.0% (95% CI, 93.0% to 99.9%) for T1a patients, and 97.0% (95% CI, 88.6% to 99.2%) for T1b patients. Locoregional plus distant 5-year invasive RFI was 97.0% (95% CI, 90.9% to 99.0%) for T1a and 91.9% (95% CI, 81.5% to 96.6%) for T1b patients; it was 89.4% (95% CI, 70.6% to 96.5%) for T1b tumors reported at 1.0 cm. T1b tumors reported at 1.0 cm accounted for 24% of the T1ab cohort, 61% of the cohort total tumor volume, and 75% of distant recurrences. Invasive RFI for T1b 1.0 cm tumors was lower than that for T1a tumors: 84.5% versus 97.4% (P = .009).

Conclusion The distant IR risk of T1a HER2-positive breast cancer appears quite low. The distant IR risk in T1b patients, particularly those with 1.0-cm tumors, is higher. Potential risk differences for T1a and T1b, including the 1.0-cm tumors, should be considered when making treatment decisions.

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所有跟帖： 

• 原来Kaiser的医生科研水平这么高! 赞! -cawan- ♀ (0 bytes) () 06/04/2014 postreply 08:33:57

• 有很多细节要考虑到，意义不很大的文章。 -johndoe26- ♂ (0 bytes) () 06/05/2014 postreply 22:37:57