MJA：早期乳腺癌发生转移的可能性

根据发表在6月18日的Medical Journal of Australia杂志上的一项研究论文的研究作者称：诊断患有早期乳腺癌的妇女如今可以提供有关预后的重要信息。

十分之一的澳大利亚妇女诊断患有与非转移性乳腺癌，并且预测会在5年内发展转移性疾病。悉尼NHMRC临床试验中心Sarah Lord表示：但如果癌细胞已扩散到邻近淋巴结或邻近组织，5年内发生转移的风险上升到六分之一。

研究人员研究了新南威尔士州6644名在2001年和2002年间确诊患有与非转移性乳腺癌的妇女，以确定有多少人会发展成转移性疾病。这些妇女与非转移性乳腺癌的妇女分为两组：局部肿瘤患者（那些肿瘤只局限于乳房组织）和区域肿瘤患者（那些肿瘤蔓延到区域淋巴结或邻近组织）。

两组发生转移性疾病的整体风险为10％，但对于那些局部癌症患者来说，只有在二十分之一的可能性会继续在5年之内发展成转移性乳腺癌（MBC）。

作者说：他们的研究结果表明除了肿瘤生物学外，诊断肿瘤疾病的传播情况仍然是一个重要的预后因素。临床医师可以使用这些评估预后因素告知患有乳腺癌的妇女发展成MBC的平均风险。

doi:10.5694/mja12.10026
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Incidence of metastatic breast cancer in an Australian population-based cohort of women with non-metastatic breast cancer at diagnosis

Sarah J Lord, M Luke Marinovich, Jillian A Patterson, Nicholas Wilcken, Belinda E Kiely, Val Gebski, Sally Crossing, David M Roder, Melina Gattellari and Nehmat Houssami

Objectives: To estimate the incidence of metastatic breast cancer (MBC) in Australian women with an initial diagnosis of non-metastatic breast cancer.

Design, setting and participants: A population-based cohort study of all women with non-metastatic breast cancer registered on the New South Wales Central Cancer Register (CCR) in 2001 and 2002 who received care in a NSW hospital.

Main outcome measures: 5-year cumulative incidence of MBC; prognostic factors for MBC.

Results: MBC was recorded within 5 years in 218 of 4137 women with localised node-negative disease (5-year cumulative incidence, 5.3%; 95% CI, 4.6%–6.0%); and 455 of 2507 women with regional disease (5-year cumulative incidence, 18.1%; 95% CI, 16.7%–19.7%). The hazard rate for developing MBC was highest in the second year after the initial diagnosis of breast cancer. Determinants of increased risk of MBC were regional disease at diagnosis, age less than 50 years and living in an area of lower socio-economic status.

Conclusions: Our Australian population-based estimates are valuable when communicating average MBC risks to patients and planning clinical services and trials. Women with node-negative disease have a low risk of developing MBC, consistent with outcomes of adjuvant clinical trials. Regional disease at diagnosis remains an important prognostic factor.