Identifying breast cancer patients at risk for Central Nervous System (CNS) metastases in trials of the International Breast Cancer Study Group (IBCSG)

被引:324
作者
Pestalozzi, BC
Zahrieh, D
Price, KN
Holmberg, SB
Lindtner, J
Collins, J
Crivellari, D
Fey, MF
Murray, E
Pagani, O
Simoncini, E
Castiglione-Gertsch, M
Gelber, RD
Coates, AS
Goldhirsch, A
机构
[1] Univ Zurich Hosp, Dept Oncol, CH-8091 Zurich, Switzerland
[2] European Inst Oncol, Milan, Italy
[3] Univ Sydney, Sch Publ Hlth, Sydney, NSW 2006, Australia
[4] Canc Council Australia, Australian New Zealand Breast Canc Trials Grp, Sydney, NSW, Australia
[5] Univ Bern, Inselspital, Inst Med Oncol, CH-3010 Bern, Switzerland
[6] Univ Bern, Inselspital, IBCSG Coordinating Ctr, CH-3010 Bern, Switzerland
[7] Oncol Med Spedali Civili, Brescia, Italy
[8] Swiss Grp Clin Canc Res, Brescia, Italy
[9] Oncol Inst So Switzerland, Lugano, Switzerland
[10] Univ Cape Town, ZA-7700 Rondebosch, South Africa
[11] Groote Schuur Hosp, ZA-7925 Cape Town, South Africa
[12] Univ Bern, Inselspital, Dept Med Oncol, CH-3010 Bern, Switzerland
[13] Ctr Riferimento Oncol, I-33081 Aviano, Italy
[14] Royal Melbourne Hosp, Dept Surg, Australian New Zealand Breast Canc Trials Grp, Melbourne, Vic, Australia
[15] Inst Oncol, Dept Surg, Ljubljana, Slovenia
[16] SU Moelndals Hosp, Dept Surg, Molndal, Sweden
[17] Frontier Sci & Technol Res Fdn Inc, Boston, MA USA
[18] Dana Farber Canc Inst, IBCSG, Ctr Stat, Boston, MA 02115 USA
基金
英国医学研究理事会;
关键词
breast cancer; central nervous system; adjuvant chemotherapy; competing risks; CMF; metastases;
D O I
10.1093/annonc/mdl064
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: We sought to determine whether a high-risk group could be defined among patients with operable breast cancer in whom a search of occult central nervous system (CNS) metastases was justified. Patients and methods: We evaluated data from 9524 women with early breast cancer (42% node-negative) who were randomized in International Breast Cancer Study Group clinical trials between 1978 and 1999, and treated without anthracyclines, taxanes, or trastuzumab. We identified patients whose site of first event was CNS and those who had a CNS event at any time. Results: Median follow-up was 13 years. The 10-year incidence (10-yr) of CNS relapse was 5.2% (1.3% as first recurrence). Factors predictive of CNS as first recurrence included: node-positive disease (10-yr = 2.2% for > 3 N+), estrogen receptor-negative (2.3%), tumor size > 2 cm (1.7%), tumor grade 3 (2.0%), < 35 years old (2.2%), HER2-positive (2.7%), and estrogen receptor-negative and node-positive (2.6%). The risk of subsequent CNS recurrence was elevated in patients experiencing lung metastases (10-yr = 16.4%). Conclusion: Based on this large cohort we were able to define risk factors for CNS metastases, but could not define a group at sufficient risk to justify routine screening for occult CNS metastases.
引用
收藏
页码:935 / 944
页数:10
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