Prognosefaktoren für Lokal-, lokoregionäre- und systemische Rezidive beim frühen Mammakarzinom

Zusammenfassung

Fragestellung: Das Rezidivrisiko beim Mammakarzinom wird durch therapeutische Faktoren, aber auch durch den intrinsischen Subtyp beeinflusst. Diese Arbeit analysiert Risikofaktoren für lokales und lokoregionäres Rezidiv sowie systemische Rezidive, die Evaluation eventuell vorhandener Unterschiede sowie die Analyse des Rezidivrisikos in verschiedenen molekularen Subtypen.

Material/Methoden: Analysiert wurden 3054 Patientinnen mit Mammakarzinom, die an den HSK-Wiesbaden und Kliniken Essen-Mitte zwischen 1998–2011 operiert und adjuvant behandelt wurden. Anhand immunhistochemischer Parameter erfolgte die Subgruppierung in Luminal A, Luminal B/HER2−, Luminal B/HER2+, HER2+ und TNBC.

Ergebnisse: 67 % der Tumoren wurden als Luminal A, 13 % Luminal B/HER2−, 6 % Luminal B/HER2 +, 3 % HER2+ und 11 % TNBC kategorisiert. Nach einer medianen Nachbeobachtung von 6,6 Jahren traten 100 lokale (3,3 %), 32 lokoregionäre (1 %) Rezidive und 248 Fernmetastasen (8 %) auf. Das metastasenfreie 5-Jahres-Überleben für das Gesamtkollektiv betrug 92 %. In den multivariaten Analysen waren ein positiver Nodalstatus, der TNBC-Subtyp und die nicht durchgeführte Radiotherapie unabhängige Risikofaktoren für alle Rezidivformen. Für das Lokalrezidiv waren zudem Alter < 50 Jahre, Tumorgröße, Luminal B/HER2− und die brusterhaltende Therapie unabhängige Risikofaktoren. Das Risiko für systemische Rezidive war verglichen mit dem Luminal-A-Subtyp in allen weiteren Subtypen erhöht, neben dem Nachweis einer Lymphgefäßinvasion, nicht erfolgter Systemtherapie und Mastektomie.

Schlussfolgerung: Insgesamt zeigt sich ein niedriges Risiko für lokale und lokoregionäre Rezidive. Neben dem Nodalstatus ist vor allem die Subgruppenklassifikation ausschlaggebend.

Abstract

Aim: The risk of recurrence in breast cancer depends on factors such as treatment but also on the intrinsic subtype. We analyzed the risk factors for local, loco-regional and systemic recurrence, evaluated the differences and analyzed the risk of recurrence for different molecular subtypes.

Material and Methods: A total of 3054 breast cancer patients who underwent surgery followed by adjuvant treatment at HSK hospital or Essen Mitte Hospital between 1998 and 2011 were analyzed. Based on immunohistochemical parameters, cancers were divided into the following subgroups: luminal A, luminal B (HER2−), luminal B (HER2+), HER2+ and TNBC (triple negative breast cancer).

Results: 67 % of tumors were classified as luminal A, 13 % as luminal B (HER2−), 6 % as luminal B (HER2+), 3 % as HER2+ and 11 % as TNBC. After a median follow-up time of 6.6 years there were 100 local (3.3 %), 32 loco-regional (1 %) and 248 distant recurrences (8 %). Five-year recurrence-free survival for the overall patient collective was 92 %. On multivariate analysis, positive nodal status, TNBC subtype and absence of radiation therapy were found to be independent risk factors for all forms of recurrence. Age < 50 years, tumor size, luminal B (HER2−) subtype and breast-conserving therapy were additional risk factors for local recurrence. Compared to the luminal A subtype, the risk of systemic recurrence was higher for all other subtypes; additional risk factors for systemic recurrence were lymphatic invasion, absence of systemic therapy and mastectomy.

Conclusion: Overall, the risk of local and loco-regional recurrence was low. In addition to nodal status, subgroup classification was found to be an important factor affecting the risk of recurrence.

Schlüsselwörter

Hormonrezeptor - Her2/neu - Mammakarzinom

Key words

hormone receptor - HER2/neu - breast cancer

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