Mustafa ÜNSAL, Ömür ALAN, Mehmet YALÇINER, Elif BERBEROĞLU, Dönmez Binnur YILMAZ, Mustafa İZMİRLİ

Evre I-III meme kanserli hastalarda adjuvan tedavi sonuçları ve prognostik faktörler

AMAÇ Bu çalışmada meme kanserli kadın hastalarda adjuvan tedavi sonuçları ve prognostik faktörler incelendi.GEREÇ VE YÖNTEM 1995 yılında SSK Okmeydanı Eğitim Hastanesi Radyasyon Onkolojisi Kliniği'ne başvuran, tedavi ve takipleri aynı klinikte yapılan, ameliyatlı evre I-III meme kanserli 197 kadın hasta (ort. yaş 51; dağılım 18-80) retrospektif olarak incelendi.BULGULAR Hastaların %41.1'i premenopoze, %58.9'u postmenopoze idi. En sık tümör histolojisi (%85.8) invaziv duktal karsinomdu. En sık evre ise (%49.7) IIB'di. Cerrahi müdahale olarak olguların %65.0'ine modifiye radikal mastektomi yapıldı. Adjuvan tedavi olarak hastaların %46.7'sine siklofosfamid-metotreksat-florourasil kemoterapisi, %23.4'üne antrasiklinli kemoterapi rejimleri uygulandı. Hastaların %75.6'sına hormonoterapi verildi, %69.0'ına radyoterapi uygulandı. Lokal ve bölgesel nüks %13.2 hastada, uzak metastaz %26.4 hastada gelişti. Hastaların %7.1'inde lokal nüks ve uzak metastaz birlikte görüldü. Medyan 89 aylık (4-108) takip sonucu, %60.9'u hastalıksız, %1'i lokal nükslü olarak takibi sürdü. Genel sağkalım oranları 5 yıllık %68, 8 yıllık %61 ve hastalıksız sağkalım 5 yıllık %66, 8 yıllık için ise %60 oldu. Tek değişkenli analizlerde, aksillada tutulan lenf nodu sayısının, tümör boyutunun ve evrenin artması daha kısa genel sağkalım ve hastalıksız sağkalım ile sonuçlandı. Çok değişkenli analizlerde ise aksillada tutulan lenf nodu sayısı (p=0.001) ve tümör boyutu (p=0.001) genel sağkalım ve hastalıksız sağkalımı anlamlı olarak etkilemediği görüldü.SONUÇ Bu çalışmada meme kanserli hastalarda tümör boyutu ve aksillada tutulan lenf nodu sayısı anlamlı oranda prognostik faktörler olarak bulundu.

Adjuvant treatment results and prognostic factors in patients with stage I-III operated breast cancer

OBJECTIVES We evaluated the adjuvant treatment results and prognostic factors in patients with breast cancer.METHODS A total of 197 stage I-III breast cancer patients (mean age 51; range 18 to 80 years) treated and followed up by Okmeydanı Training Hospital, Department of Radiation Oncology in 1995 were evaluated retrospectively.RESULTS The 41.1% of patients were premenopausal and the remaining were postmenopausal. Invasive ductal carcinoma was encountered as the most frequent (85.8%) histopathologic type of tumor and most frequent (%49.7) stage was IIB. Modified radical mastectomy was performed on 65% of patients. In adjuvant treatment, cyclophosphamide- methotrexate-fluorouracil combinations and anthracycline containing combinations were given to 46.7% and 23.4% of patients respectively. In addition, endocrine therapy and radiotherapy was carried out on the 75.6% and 69.0% of patients. Local recurrences was occurred in a rate of 13.2% and distant metastases were observed in a rate of 26.4% and 7.1% of patients had both local recurrences and distant metastases. The 60.9% of patients were disease free and 1% with local recurrences also they were followed-up for a median time of 89 months (4-108). The overall survival rate and disease free survival rates for 5 and 8 years were as follows; 68%, 61%, 66%, and 60% respectively. With one variable analysis increased number of involved axillary lymph nodes, tumor size and stage gave rise to reduced overall survival rate and disease free survival rate. With multiple variable analysis, number of involved axillary lymph nodes (p=0.001) and tumor size (p=0.001) had significant effect on overall survival rate and disease free survival rate.CONCLUSION The tumor size and number of involved axillary lymph nodes were found to be statistically significant prognostic factors in breast cancer patients in our study.

PDF

___

1) Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55(2):74-108.
2) Darendeliler E, Ağaoğlu FY. Meme kanserinin epidemiyolojisi ve etyolojisi. In: Topuz E, Aydıner A, Dinçer M, editörler. Meme kanseri. Nobel Tıp Kitabevleri; 2003. s. 13-33.
3) Kanserle savaş politikası ve kanser verileri (1995-1999). T.C. Sağlık Bakanlığı Kanser Savaş Dairesi Başkanlığı; Bakanlık Yayın No: 618, Ankara: 2002. s. 145.
4) Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 1989;63(1):181-7.
5) Veronesi U, Costa A, Zurrida S, Goldhirsch A, Colleoni M, Cinieri S, et al.; European Institute of Oncology; European School of Oncology. Breast cancer at the end of a successful century: meeting highlights from the First Milan Breast Cancer Conference and discussion paper for the Second Conference (Milan, 14-16 June, 2000). Breast 2000;9(3):161-70.
6) American Joint Committee on Cancer. AJCC Cancer staging Manuel. 5th ed. Philadelphia: Lippincott- Raven; 1997. p. 171-2.
7) Goldhirsch A, Wood WC, Gelber RD, Coates AS, Thurlimann B, Senn HJ. Meeting highlights: updated international expert consensus on the primary therapy of early breast cancer. J Clin Oncol 2003;21(17):3357- 65.
8) Ragaz J, Jackson SM, Le N, Plenderleith IH, Spinelli JJ, Basco VE, et al. Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med 1997;337(14):956-62.
9) Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 1997;337(14):949-55.
10) Fisher B, Brown AM, Dimitrov NV, Poisson R, Redmond C, Margolese RG, et al. Two months of doxorubicin- cyclophosphamide with and without interval reinduction therapy compared with 6 months of cyclophosphamide, methotrexate, and fluorouracil in positive-node breast cancer patients with tamoxifennonresponsive tumors: results from the National Surgical Adjuvant Breast and Bowel Project B-15. J Clin Oncol 1990;8(9):1483-96.
11) Tamoxifen for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists' Collaborative Group. Lancet 1998;351(9114):1451 67.
12) Horton J. Follow-up of breast cancer patients. Cancer 1984;53(3 Suppl):790 7.
13) Chevallier B, Heintzmann F, Mosseri V, Dauce JP, Bastit P, Graic Y, et al. Prognostic value of estrogen and progesterone receptors in operable breast cancer. Results of a univariate and multivariate analysis. Cancer 1988;62(12):2517-24.
14) Tormey DC, Gray R, Abeloff MD, Roseman DL, Gilchrist KW, Barylak EJ, et al. Adjuvant therapy with a doxorubicin regimen and long-term tamoxifen in premenopausal breast cancer patients: an Eastern Cooperative Oncology Group trial. J Clin Oncol 1992;10(12):1848-56.
15) Rosen PP, Groshen S, Kinne DW, Norton L. Factors influencing prognosis in node-negative breast carcinoma: analysis of 767 T1N0M0/T2N0M0 patients with long-term follow-up. J Clin Oncol 1993;11(11):2090- 100.
16) Going JJ, Mallon EA, Leake RE, Bartlett JM, Gusterson BA. What the clinician needs from the pathologist: evidence-based reporting in breast cancer. Eur J Cancer 2001;37 Suppl 7:S5-17.
17) Silverstein MJ, Skinner KA, Lomis TJ. Predicting axillary nodal positivity in 2282 patients with breast carcinoma. World J Surg 2001;25(6):767-72.
18) Nixon AJ, Neuberg D, Hayes DF, Gelman R, Connolly JL, Schnitt S, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol 1994;12(5):888-94.
19) Fisher ER, Anderson S, Redmond C, Fisher B. Pathologic findings from the National Surg i c a l Adjuvant Breast Project protocol B-06. 10-year pathologic and clinical prognostic discriminants. Cancer 1993;71(8):2507-14.