Chemotherapy and hormonal treatments improve the 15 year survival rate
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《英国医生杂志》
Chemotherapy and hormonal therapy achieve long term improvements in survival in women with breast cancer, with even greater increases in 15 year survival than five year survival. These are the latest findings from a five yearly meta-analysis published last week ( Lancet 2005;365: 1687-717).
The Early Breast Cancer Trialists' Collaborative Group coordinated the world's largest collaborative analysis of cancer trials, including data from 145 000 women with early breast cancer who had been studied in 194 randomised trials.
The group assessed the effects after 10 years and 15 years of a range of breast cancer treatments that were being tested in the 1980s, and have since been widely adopted. These included six months of anthracycline based chemotherapy (anthracycline combined with fluorouracil and cyclophosphamide) and five years of treatment with tamoxifen.
As the analysis was restricted to trials that began by 1995, none included newer treatments such as taxanes, trastuzumab, or modern aromatase inhibitors.
The results showed that treatment with both chemotherapy and hormonal therapy approximately halved the 15 year risk of death from breast cancer, with the survival curves for women treated with these therapies diverging over time compared with those not given them.
Six months of anthracycline based chemotherapy reduced the annual death rate from breast cancer by about 38% (SE 5) for women aged younger than 50 years at the time of diagnosis and by about 20% (4) for those aged 50-69 years when diagnosed. These reductions in breast cancer mortality were largely irrespective of the use of tamoxifen and of oestrogen receptor status, nodal status, or other tumour characteristics.
Chemotherapy regimens based on anthracycline were significantly more effective than CMF (cyclophosphamide, methotrexate, fluorouracil) chemotherapy.
For women with oestrogen receptor positive breast cancer, five years of adjuvant tamoxifen reduced the annual breast cancer death rate by 31% (SE 3), largely irrespective of the use of chemotherapy and of age, progesterone receptor status, or other tumour characteristics.
Five years' treatment was significantly more effective than just one to two years of tamoxifen (2P<0.00 001 for recurrence, 2P=0.01 for breast cancer mortality). For oestrogen receptor positive tumours, the cumulative reduction in mortality was more than twice as big at 15 years as at five years after diagnosis.
Professor Sarah Darby, professor of medical statistics at the clinical trial service unit, University of Oxford, said on behalf of the collaborative group: "For middleaged women with hormone sensitive breast cancer, six months of anthracycline based chemotherapy and five years of tamoxifen halves the long term risk of death from the disease."(Susan Mayor)
The Early Breast Cancer Trialists' Collaborative Group coordinated the world's largest collaborative analysis of cancer trials, including data from 145 000 women with early breast cancer who had been studied in 194 randomised trials.
The group assessed the effects after 10 years and 15 years of a range of breast cancer treatments that were being tested in the 1980s, and have since been widely adopted. These included six months of anthracycline based chemotherapy (anthracycline combined with fluorouracil and cyclophosphamide) and five years of treatment with tamoxifen.
As the analysis was restricted to trials that began by 1995, none included newer treatments such as taxanes, trastuzumab, or modern aromatase inhibitors.
The results showed that treatment with both chemotherapy and hormonal therapy approximately halved the 15 year risk of death from breast cancer, with the survival curves for women treated with these therapies diverging over time compared with those not given them.
Six months of anthracycline based chemotherapy reduced the annual death rate from breast cancer by about 38% (SE 5) for women aged younger than 50 years at the time of diagnosis and by about 20% (4) for those aged 50-69 years when diagnosed. These reductions in breast cancer mortality were largely irrespective of the use of tamoxifen and of oestrogen receptor status, nodal status, or other tumour characteristics.
Chemotherapy regimens based on anthracycline were significantly more effective than CMF (cyclophosphamide, methotrexate, fluorouracil) chemotherapy.
For women with oestrogen receptor positive breast cancer, five years of adjuvant tamoxifen reduced the annual breast cancer death rate by 31% (SE 3), largely irrespective of the use of chemotherapy and of age, progesterone receptor status, or other tumour characteristics.
Five years' treatment was significantly more effective than just one to two years of tamoxifen (2P<0.00 001 for recurrence, 2P=0.01 for breast cancer mortality). For oestrogen receptor positive tumours, the cumulative reduction in mortality was more than twice as big at 15 years as at five years after diagnosis.
Professor Sarah Darby, professor of medical statistics at the clinical trial service unit, University of Oxford, said on behalf of the collaborative group: "For middleaged women with hormone sensitive breast cancer, six months of anthracycline based chemotherapy and five years of tamoxifen halves the long term risk of death from the disease."(Susan Mayor)