Prognosefaktoren für das Rezidiv beim Mammakarzinom am Kollektiv der HSK Wiesbaden 1998 – 2003

Zusammenfassung

Fragestellung: Anhand einer Nachbeobachtung unseres Patientenkollektivs wurden Prädiktoren und Prognosefaktoren für das Auftreten eines Rezidivs des Mammakarzinoms und des Gesamtüberlebens untersucht. Ziel der Untersuchung war es, Prädiktoren und Prognosefaktoren für das Auftreten von Lokalrezidiven oder Fernmetastasen zu identifizieren. Außerdem wurde geprüft, welchen Einfluss das Auftreten eines lokoregionären Rezidivs auf das Gesamtüberleben hat. Material und Methodik: Von 1/1998 – 12/2003 wurden 1313 Patientinnen mit unilateralem primär nicht metastasierten Mammakarzinom an unserer Klinik diagnostiziert und operiert. Die Nachbeobachtung betrug median 45 Monate. Mittels univariater und multivariater Analyse wurden relevante Prognosefaktoren isoliert. Ergebnisse: 66 Patientinnen (5 %) entwickelten ein lokoregionäres Rezidiv, bei 91 Patientinnen (6,9 %) trat eine Fernmetastasierung auf. Signifikante Prognosefaktoren für das Auftreten eines lokoregionären Rezidivs waren in der multivariaten Analyse Tumorgröße (T3/4-Tumoren, OR 4,4 [2,0 – 9,5] 95 %-KI; p = 0,000), positiver Nodalstatus (OR 1,3 [1,05 – 3,3] 95 %-KI; p = 0,006) und negativer Rezeptorstatus (OR 3,9 [1,4 – 10,8] 95 %-KI; p = 0,000). Hinsichtlich des Auftretens von Fernmetastasen war zusätzlich die multizentrische/multifokale Tumorlokalisation (OR 1,7 [1,1 – 2,7] 95 %-KI; p = 0,029) von Bedeutung. Mit einem schlechteren Gesamtüberleben waren neben Alter > 70 Jahren und fortgeschrittener Tumorgröße auch eine Lymphangiosis carcinomatosa des Primärtumors (OR 7,2 [1,1 – 46,5] 95 %-KI; p = 0,038) und das Auftreten eines lokoregionären Rezidivs (OR 7,4 [3,3 – 16,8] 95 %-KI; p = 0,000) assoziiert. Schlussfolgerung: Bekannte Prognosefaktoren konnten bestätigt werden, so auch insbesondere der Einfluss des negativen Rezeptorstatus auf die Lokalrezidivrate. Die Bedeutung des lokoregionären Rezidivs als Prognosefaktor für ein schlechteres Gesamtüberleben konnte gezeigt werden.

Abstract

Purpose: In a retrospective analysis we examined the risk factors for locoregional failure, distant metastasis and poorer overall survival. In addition we tried to elucidate whether locoregional failure has an impact on overall survival (OS). Patients and methods: Our population consisted of 1313 patients with primary non-metastatic breast cancer or DCIS treated at the certified Breast Centre of the HSK Wiesbaden, Germany from 1998 – 2003. The median follow-up was 45 months. Using mono- and multivariate analysis we studied the impact of patient and tumour characteristics on locoregional failure, distant failure and overall survival. Results: 66 (5 %) patients developed locoregional failure and 91 patients (6.9 %) had distant failure as their first relapse. Factors which showed an independent impact on the locoregional recurrence rate in multivariate analysis were tumour size (T3/4 tumours OR 4.4 (2.0 – 9.5) 95 % CI; p = 0.000), positive nodal status (OR 1.3 [0.5 – 3.3] 95 % CI; p = 0.006) and hormone receptor negative tumours (OR 3.9 [1.4 – 10.8] 95 % CI; p = 0.000). An additional impact on distant failure was found for multicentric tumour localization (OR 7.2 [1.1 – 46.5] 95 % CI; p = 0.038). In addition to age > 70 and tumour size, poorer OS was associated with lymphangiosis carcinomatosa (OR 7.2 [1.1 – 46.5] 95 % CI; p = 0.038) and locoregional failure (OR 7.4 [3.3 – 16.8] 95 % CI; p = 0.000). Conclusion: We could prove the impact of established prognostic factors and particularly of a negative hormone receptor status on locoregional failure. In addition we found a strong influence of locoregional relapse on a poorer OS.

Mammakarzinom - Prognosefaktor - lokoregionäres Rezidiv - Fernmetastasen - Gesamtüberleben

breast cancer - prognostic factor - locoregional failure - distant failure - overall survival

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