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Menstrual cycle and timing of breast surgery in premenopausal node-positive breast cancer: Results of the International Breast Cancer Study Group (IBCSG) Trial VI

Goldhirsch, A. ; Gelber, R. D. ; Castiglione, M. ; O'Neill, A. ; Thürlimann, B. ; Rudenstam, C.-M ; Lindtner, J. ; Collins, J. ; Forbes, J. ; Crivellari, D. ; Coates, A. ; Cavalli, F. ; Simoncini, E. ; Fey, M. F. ; Pagani, O. ; Price, K. ; Senn, H.-J

In: Annals of Oncology, 1997, vol. 8, no. 8, p. 751-756

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    Titre
    • Menstrual cycle and timing of breast surgery in premenopausal node-positive breast cancer: Results of the International Breast Cancer Study Group (IBCSG) Trial VI
    Auteur
    • Goldhirsch, A.. International Breast Cancer Study Group Bern, Switzerland
    • Gelber, R. D.. Dana-Farber Cancer Institute and Harvard Medical School Boston, MA, USA
    • Castiglione, M.. International Breast Cancer Study Group Bern, Switzerland
    • O'Neill, A.. Dana-Farber Cancer Institute and Harvard Medical School Boston, MA, USA
    • Thürlimann, B.. Kantonsspital, St. Gallen
    • Rudenstam, C.-M. West Swedish Breast Cancer Study Group Gōteborg, Sweden
    • Lindtner, J.. The Institute of Oncology Ljubljana, Slovenia
    • Collins, J.. Anti-Cancer Counsil of Victoria Melbourne, Australia
    • Forbes, J.. University of Newcastle Waratah, Australia
    • Crivellari, D.. Centro di Riferimento Oncologico Aviano, Italy
    • Coates, A.. University of Sydney and Royal Prince Alfred Hospital Sydney, Australia
    • Cavalli, F.. Ospedale San Giovanni Bellinzona
    • Simoncini, E.. Spedali Civili & Fondazione Beretta Brescia, Italy
    • Fey, M. F.. SAKK (Swiss Group for Clinical Cancer Research) Inselspital, Bern
    • Pagani, O.
    • Price, K.. Dana-Farber Cancer Institute and Harvard Medical School Boston, MA, USA
    • Senn, H.-J. SAKK (Swiss Group for Clinical Cancer Research) Inselspital, Bern
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • Annals of Oncology, 1997, vol. 8, no. 8, p. 751-756. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:290859
    Summary
    Purpose It has been postulated that breast cancer surgery performed during the follicular phase of the menstrual cycle is associated with poorer outcome. Patients and methods We tested this hypothesis by evaluating disease-free survival (DFS) for 1033 premenopausal patients who received definitive surgery either during the follicular phase (n = 358) or the luteal phase (n = 675). All patients were enrolled in a randomized trial conducted between July 1986 and April 1993. All had node positive breast cancer and randomization was stratified by estrogen receptor (ER) status. AU patients received at least three cycles of adjuvant cyclophosphamide, methotrexate, and 5-fluorouracil (CMF). The median follow-up was 60 months. Results Patients who underwent definitive surgery for breast cancer in the follicular phase had a slightly worse disease-free survival than those operated on during the luteal phase (five-year DFS percentage: 53% versus 58%; hazard ratio, 1.13; 95% confidence interval (CI), 0.94-1.38; P = 0.20). The effect was significantly greater for the subpopulation of 300 patients with ER-negative primaries (P = 0.02 interaction effect; five-year DFS percentages 42% vs. 59%; hazard ratio 1.60; 95% CI, 1.12-2.25; P 0.008). The effect of timing of surgery diminished for analyses based on lesser surgical procedures, e.g., excisional biopsies. In particular, no effect of timing was observed for fine needle aspiration procedures. Conclusion Surgical procedures which are more extensive than a fine needle aspiration biopsy might be associated with worse prognosis if conducted during the follicular phase of the menstrual cycle. This phenomenon was seen predominantly for high risk breast cancer with low levels or no estrogen receptors in the primary tumor