Author/Editor     Gruber, Guenther; Bonetti, Marco; Nasi, Laura M; Price, Karen; Castiglione-Gertsch, Monica; Rudenstam, Carl-Magnus; Holmberg, Stig B; Lindtner, Jurij; Golouh, Rastko; Collins, John
Title     Prognostic value of extracapsular tumor spread for locoregional control in premenopausal patients with node-positive breast cancer treated with classical cyclophosphamide, methotrexate, and fluorouracil: long-term observations from international breast cancer study group trial VI
Type     članek
Source     J Clin Oncol
Vol. and No.     Letnik 23, št. 28
Publication year     2005
Volume     str. 1089-97
Language     eng
Abstract     Purpose We sought to determine retrospective!y whether extracapsular spread (ECS) might identify a subgroup that could benefit from radiotherapy after mastectomy, especially patients with 1 to 3 positive lymph nodes (LN1-3+). Patients and Methods We randomized 1,475 premenopausal women with node-positive breast cancer to three, six, or nine courses of "classical" CMF (cyclophosphamide, methotrexate, and fluorouracil). After a review of all pathology forms, 933 patients (63%) had information on the presence or absence of ECS. ECS was present in 49.5%. The median follow-up was 10 years. Results In univariate analyses, ECS was associated with worse disease-free survival (DFS) and overall survival (OS). In multivariate analyses adjusting for tumor size, vessel invasion, surgery type, and age group, ECS remained significant (DFS: hazard ratio, 1.61; 95% CI, 1.34 to 1.93; P <.0001; OS: 1.67; 95% CI, 1.34 to 2.08; P<.0001). However, ECS was not significant when the number of positive nodes was added. The locoregional failure rate +- distant failure (LRF +- distant failure) within 10 years was estimated at 19% (+-2%) without ECS, versus 27% (+- 2%) with ECS. The difference was statistically significant in univariate analyses, but not after adjusting for the number of positive nodes. No independent effect of ECS on DFS, OS, or LRF could be confirmed within the subgroup of 382 patients with LN1-3+ treated with mastectomy without radiotherapy. Conclusion Our results do not support an independent prognostic value of ECS, nor its use as an indication for irradiation in premenopausal patients with LN1-3+ treated with classical CMF. However, we could not examine vvhether extensive ECS is of prognostic importance.
Descriptors     BREAST NEOPLASMS
LYMPH NODES
ANTINEOPLASTIC AGENTS, COMBINED
NEOPLASM INVASIVENESS
NEOPLASM RECURRENCE, LOCAL
AGE FACTORS
CYCLOPHOSPHAMIDE
DISEASE-FREE SURVIVAL
LYMPHATIC METASTASIS
MASTECTOMY
METHOTREXATE
NEOPLASM STAGING
POSTMENOPAUSE
RETROSPECTIVE STUDIES