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

Publication

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

Journal Paper/Review - Oct 1, 2005

Gruber Günther, Goldhirsch Aron, Coates Alan S, Gelber Richard D, Fey Martin F, Simoncini Edda, Thürlimann Beat, Carbone Antonino, Crivellari Diana, Collins John, Golouh Rastko, Lindtner Jurij, Holmberg Stig B, Rudenstam Carl-Magnus, Castiglione-Gertsch Monica, Price Karen N, Nasi M Laura, Bonetti Marco, International Breast Cancer Study Group

Citation

Gruber G, Goldhirsch A, Coates A, Gelber R, Fey M, Simoncini E, Thürlimann B, Carbone A, Crivellari D, Collins J, Golouh R, Lindtner J, Holmberg S, Rudenstam C, Castiglione-Gertsch M, Price K, Nasi M, Bonetti M, International Breast Cancer Study Group. 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. JCO 2005; 23:7089-97.

Type

Journal Paper/Review (English)

Journal

JCO 2005; 23

Publication Date

Oct 1, 2005

Issn Print

0732-183X

Pages

7089-97

Brief description/objective

PURPOSE: We sought to determine retrospectively 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 whether extensive ECS is of prognostic importance.