CONTRALATERAL BREAST-CANCER - CLINICAL CHARACTERISTICS AND IMPACT ON PROGNOSIS

被引:140
作者
HEALEY, EA
COOK, EF
ORAV, EJ
SCHNITT, SJ
CONNOLLY, JL
HARRIS, JR
机构
[1] BRIGHAM & WOMENS HOSP,DEPT MED,DIV CLIN EPIDEMIOL,BOSTON,MA 02115
[2] HARVARD UNIV,SCH PUBL HLTH,DEPT EPIDEMIOL,BOSTON,MA 02115
[3] HARVARD UNIV,SCH PUBL HLTH,DEPT BIOSTAT,BOSTON,MA 02115
[4] HARVARD UNIV,BETH ISRAEL HOSP,SCH MED,DEPT PATHOL,BOSTON,MA 02215
关键词
D O I
10.1200/JCO.1993.11.8.1545
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To determine the characteristics of patients with unilateral breast cancer who subsequently develop contralateral breast cancer (CBC), to assess their prognosis relative to patients who do not develop a CBC, and to assess the feasibility of using conservative surgery (CS) and radiotherapy (RT) to treat CBC. Materials and Methods: Of 1,624 women treated with CS and RT for unilateral stage I or II breast cancer at the Joint Center for Radiation Therapy, 77 developed an invasive CBC. Sixty-two CBCs were treated with CS and RT. The median follow-up duration was 95 months from the time of initial breast cancer diagnosis, and 63 months from CBC diagnosis. Results: The cumulative actuarial rate of CBC was 7.0% at 10 years, and the annual incidence rate for CBC was relatively constant. Young age predicted for CBC. When age was analyzed by decade the relative risk (RR) for older patients compared with younger patients was 0.79 (95% confidence interval [Cl], 0.62 to 1.01). The presence of lobular carcinoma in situ (LCIS), higher tumor stage, and lack of adjuvant systemic therapy also predicted for CBC with borderline significance. Multivariate analyses showed that CBC was associated with a statistically significant greater likelihood of local recurrence (LR) or distant recurrence (RR, 1.68; 95% Cl, 1.03 to 2.71), and distant-only recurrence (RR, 2.17; 95% Cl, 1.28 to 3.69). Among assessable patients treated with bilateral RT, 28 of 31 ipsilateral and 11 of 11 contralateral breasts had an excellent or good overall cosmetic outcome at 5 years, and treatment-related complications were minimal. Conclusion: We conclude that (1) young age is associated with a greater likelihood of CBC, (2) patients who develop a CBC have a greater subsequent risk of distant relapse as compared with patients without CBC, and (3) it is feasible to deliver sequential nonoverlapping bilateral RT without compromising the cosmetic outcome or increasing complications.
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收藏
页码:1545 / 1552
页数:8
相关论文
共 51 条
[1]  
ADAMI HO, 1985, CANCER, V55, P643, DOI 10.1002/1097-0142(19850201)55:3<643::AID-CNCR2820550328>3.0.CO
[2]  
2-L
[3]  
ANDERSEN JA, 1974, ACTA PATH MICRO IM A, VA 82, P519
[4]  
ANDERSON DE, 1971, CANCER, V28, P1500, DOI 10.1002/1097-0142(197112)28:6<1500::AID-CNCR2820280623>3.0.CO
[5]  
2-D
[6]  
ANDERSON DE, 1974, CANCER, V34, P1090, DOI 10.1002/1097-0142(197410)34:4<1090::AID-CNCR2820340419>3.0.CO
[7]  
2-J
[8]   THE GENETIC EPIDEMIOLOGY OF 2ND PRIMARY BREAST-CANCER [J].
BERNSTEIN, JL ;
THOMPSON, WD ;
RISCH, N ;
HOLFORD, TR .
AMERICAN JOURNAL OF EPIDEMIOLOGY, 1992, 136 (08) :937-948
[9]   RISK-FACTORS PREDICTING THE INCIDENCE OF 2ND PRIMARY BREAST-CANCER AMONG WOMEN DIAGNOSED WITH A 1ST PRIMARY BREAST-CANCER [J].
BERNSTEIN, JL ;
THOMPSON, WD ;
RISCH, N ;
HOLFORD, TR .
AMERICAN JOURNAL OF EPIDEMIOLOGY, 1992, 136 (08) :925-936
[10]   CANCER IN THE CONTRALATERAL BREAST AFTER RADIOTHERAPY FOR BREAST-CANCER [J].
BOICE, JD ;
HARVEY, EB ;
BLETTNER, M ;
STOVALL, M ;
FLANNERY, JT .
NEW ENGLAND JOURNAL OF MEDICINE, 1992, 326 (12) :781-785