早期乳腺癌进展 青岛

,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,早期乳腺癌辅助治疗进展,复旦大学肿瘤医院,乳腺外科,/,乳腺癌研究所,陆劲松,乳腺癌辅助化疗的进展,1970,1985,CMF,方案,口服,/,静脉给药,6,月,/1,年,+/-,强的松,1986,97,CEF,蒽环类方案,阿霉素,/,表阿霉素,低剂量,/,高剂量,+/- 5FU,1998,FEC-P,紫杉类方案,2008-8-28,2,复旦大学肿瘤医院乳腺癌研究所,EBCTCG,荟萃分析,2005-06,乳腺癌死亡率,10,0,5,10,0,5,10,0,5,10,50,0,40,30,20,死亡率,(%/,年,:,无复发妇女的总死亡率,),和,logrank,分析,蒽环类,%,紫杉类,%,%,+,SE,10,年获益,%,(SE 1.6),年,10,年获益,%,(SE 1.0),10,年获益,%,(SE 1.0),年,年,%,蒽环类,%,%,%,紫杉类,蒽环类,CMF ,无化疗,Peto R,代表早期乳腺癌试验协作组(,EBCTCG),于,2007,年,12,月,13,日在,SABCS,上发言,2008-8-28,3,复旦大学肿瘤医院乳腺癌研究所,：,CEF,较,CMF,显著提高,10,年无复发生存率,HR=1.31 (95%CI:1.06-1.61),P=0.007,无复发生存率,(%),时间,(,年,),0,20,40,60,80,100,5,10,52%,45%,CEF (n=351),CMF (n=359),10,年绝对获益,7%,Levine MN, et al. J Clin Oncol 2005; 23:5166-5170.,：,CEF,较,CMF,显著提高,10,年总生存率,HR=1.18 (95%CI:0.94-1.49),P=0.047,总生存率,(%),时间,(,年,),0,20,40,60,80,100,5,10,62%,58%,CEF (n=351),CMF (n=359),10,年绝对获益,4%,Levine MN, et al. J Clin Oncol 2005; 23:5166-5170.,Poole CJ,et al. N Engl J Med, 2006; 355:1851-1862,.,NEAT,与,BR9601,研究的合并分析,(N=2391),R,E,CMF,NEAT,(N=2021),R,BR9601,(N=370),主要终点：,RFS,，,OS,次要终点：安全性，剂量强度，生活质量,NEAT,研究与,BR9601,研究：,CMF+E vs. CMF,CMF,方案联合法玛新的,RFS,显著长于,CMF,方案,Poole CJ,et al. N Engl J Med, 2006; 355:1851-1862,.,100,75,50,25,0,0,1,2,3,4,5,手术后时间,(,年,),法玛新,+CMF (n=1189),CMF (n=1202),85,91,76,69,RFS (%),CMF,方案联合法玛新的,OS,显著长于,CMF,方案,Poole CJ,et al. N Engl J Med, 2006; 355:1851-1862,.,OS (%),100,75,50,25,0,0,1,2,3,4,5,92,95,82,75,HR=0.67,95% CI=0.55-0.82,P0.001,手术后时间,(,年,),法玛新,+CMF (n=1189),CMF (n=1202),2005 EBCTCG,荟萃分析：,CMF vs.,含蒽环类方案,含蒽环类方案较,CMF,显著降低复发风险,12%,含蒽环类方案较,CMF,显著降低乳腺癌死亡风险,16%,EBCTCG. Lancet 2005; 365:1687-1717.,0.840(SE0.033),2p0.00001,治疗效应,2p,蒽环类,CMF ,无化疗,Peto R,代表早期乳腺癌试验协作组(,EBCTCG),于,2007,年,12,月,13,日在,SABCS,上发言,2008-8-28,10,复旦大学肿瘤医院乳腺癌研究所,DFS meta 分析,OS meta,ER 分组,DFS 淋巴结分组meta,BCIRG001,试验,Martin M, et al. SABCS 2010. Abstract S4-3.,BCRIG001,随访,10,年结果，,对于可切除淋巴结阳性乳腺癌妇女，,TAC(,多西他赛、多柔比星、环磷酰胺,),辅助化疗,FAC(,氟尿嘧啶、多柔比星、环磷酰胺,),BCIRG 001,研究终点和随访,研究目的,-,主要：无病生存,(ITT,人群分析,),-,次要：总生存,(ITT,人群分析,),、安全性、生活质量、肿瘤标志物,随访时间,-,前,2,年每,3,个月,1,次,-2-5,年每,6,个月,1,次,-5-10,年每年,1,次,每年检测,1,次,LVEF,，以评估长期心脏毒性,TAC: 76%,FAC: 69%,DFS at a Median 10-year Follow-up (ITT),Number at Risk,TAC,745,737,710,678,659,639,617,596,583,562,551,541,530,519,508,491,478,463,444,418,387,FAC,746,730,699,659,618,584,558,541,523,510,499,484,471,453,437,429,414,392,378,351,333,Disease-free survival probability,Disease-free survival time (months),0,6,12,18,24,30,36,42,48,54,60,66,72,78,84,90,96,102,108,114,120,BCIRG 001 ,结果,OS at a Median 10-year Follow-up (ITT),429 deaths:,188 TAC; 241 FAC,Number at Risk,TAC,745,742,732,718,704,693,677,661,650,645,635,622,612,603,594,584,571,563,547,524,495,FAC,746,740,731,724,704,684,657,642,625,608,591,581,573,557,546,532,517,501,482,460,443,Overall survival probability,0,6,12,18,24,30,36,42,48,54,60,66,72,78,84,90,96,102,108,114,120,TAC: 87%,FAC: 81%,HR=0.7495%CI: 0.610.90Log-rank P=0.002,Survival time (months),BCIRG 001 ,结果,作为不良事件报告的心脏毒性事件患者数,(%),3,级,(,轻度、对治疗反应良好,)4,级,(,严重、难治,)CHF,No. patients (%),TAC(n=744),FAC(n=736),充血性心力衰竭*,(,心功能,34,级,),Grade 3 (mild, responsive to therapy),Grade 4 (severe, refractory),26 (4),21 (3),5 (1),17 (2),14 (2),3 (0.4),Serious adverse event,23 (3),16 (2),Death due to CHF,2 (0.3),4 (1),BCIRG 001 ,心脏毒性,CHF,的累积发生率,Number at Risk,TAC,744,713,679,647,620,591,566,540,515,484,437,FAC,736,716,672,621,588,554,522,490,466,429,392,Probability of CHF,Time from randomization to CHF event (months),0,12,24,36,48,60,72,84,96,108,120,TAC,(n=744),FAC,(n=736),Number of CHF events,26,17,发生于随访的前,55,个月,13,5,发生于随访的,55120,个月,13,12,TAC,FAC,BCIRG 001 ,心脏毒性,BCIRG 001 ,心脏毒性,LVEF,变化情况,*,TAC,组和,FAC,组,CHF,的发生率分别为,3.5%,和,2.3% (,P,=0.17),多数,CHF,为,3,级,TAC,组和,FAC,组分别有,2,例和,4,例致死性,CHF,两组,LVEF,显著降低率,(,20%),相似，,(TAC,组,17%,，,FAC,组,15%),TAC,组和,FAC,组分别有,6,例,(0.8%),和,3,例,(0.4%),患者出现血液恶性肿瘤,GEICAM 9805,Adjuvant docetaxel improves disease-free survival (DFS) and overall survival (OS) in node-positive breast cancer patients.,However, many patients at diagnosis are node-negative, and the role of docetaxel in such patients is not fully established.,The GEICAM study began in 1998 and it showed that TAC is associated with a significant improvement in DFS compared with FAC, with manageable toxicity.,GEICAM 9805 ,试验设计,GEICAM 9805 ,主要入组标准,Age 1875 years,Curative surgery for unilateral T1-T3 breast carcinoma,No axillary lymph node involvement - At least 10 lymph nodes examined,At least one St Gallen 1998 high-risk criterion,- Tumor grade 2 to 3,- Tumors 2 cm,- Age 1 favors AT; *based on log-rank test,E2197,：,AT,的,3/4,级血液系统毒性明显高于,AC,Goldstein LJ, et al. J Clin Oncol 2008; 26:4092-4099.,患者,(%),3,级中性粒细胞,减少性发热与感染,3/4,级中性,粒细胞减少,3/4,级,白细胞减少,P0.05,P0.05,P4),F 500,E 100 (FEC),C 500,E 75 (ED),D 75,CO=,空白对照,H=,曲妥珠单抗,入组标准：第一次随机,组织学确诊接受完全切除的单侧乳腺癌,(T1-3, M0),N+ (,切除,5,个腋窝淋巴结,),年龄,18-65,岁间,心肝肾、血液学功能良好,既往未接受治疗,Roche H, et al. SABCS 2009.,PACS 04,：,6ED75,的,DFS,与,6FEC100,相似,无病生存概率,(%),时间,(,年,),0,1,2,3,4,5,0,25,50,75,100,6,6ED75,vs.,6FEC100,HR=0.89,95%CI=0.75-1.05,P=0.175,81.8,79.6,Roche H, et al. SABCS 2009.,PACS 04,：,6ED75,的,OS,与,6FEC100,相似,0,1,2,3,4,5,6,时间,(,年,),0,25,50,75,100,生存概率,(%),6ED75,vs.,6FEC100,HR=1.06,95%CI=0.85-1.34,P=0.588,90.3,90.1,Roche H, et al. SABCS 2009.,TACT入组情况：104个试验中心的4162例女性随机化,对照组选用情况,FEC,对照组,N=1265,E-CMF,对照组,N=824,对照组选用情况,FEC,对照组,N=1258,E-CMF,对照组,N=815,入组条件：淋巴结阳性或淋巴结阴性高危患者，完全切除浸润性乳腺癌,随 机 化,对照组：,N=2089,由各中心选择对照组方案,FEC:,E-CMF:,FEC：600/60/600 mg/m,2,q3wk8,表柔比星：,100,mg/m2 q3wk4,CMF：,经典的,Bonadonna,方案 或 经典,IV,方案4,试验组：,N=2073,所有中心统一方案,FEC-T:,FEC：600/60/600 mg/m,2,q3wk4,多烯紫杉醇：,100,mg/m2 q3wk4,或,TACT,研究：无病生存率（,DFS）,事件数/ 危险患者数,对照组: 0/2089 81/2002 154/1837 119/1660 86/1079 40(+4)/338,FEC-T,组: 0/2073 62/2006 145/1858 142/1668 84/1127 33(+7)/363,100,75,50,25,0,0 1 2 3 4 5,HR = 0.97（95% CI: 0.86-1.10）,分层,log rank,检验：,p=0.62,无病生存率（%）,随机化后时间 （年）,对照组：484/2089,5年,DFS: 73.9% (95% CI: 71.7-76.0),FEC-T,组：473/2073,5年,DFS: 74.7% (95% CI: 72.5-76.8),TACT,研究：总生存率,100,75,50,25,0,0 1 2 3 4 5,HR = 0.98 （95% CI: 0.84-1.14）,分层,log rank,检验：,生存率（%）,随机化后时间 （年）,对照组: 323/2089,5年,OS: 81.8% (95% CI: 79.7-83.7),FEC-T,组: 316/2073,5年,OS: 82.0% (95% CI: 79.9-83.9),对照组: 0/2089 25/2058 77/1971 98/1813 77/1201 38(+8)/381,FEC-T,组: 0/2073 22/2046 71/1971 101/1817 62/1246 51(+9)/404,事件数/ 危险患者数,如何正确理解紫杉类方案,合理的联合蒽环和烷化剂,避免阴性结果的方案,非蒽环类紫杉方案,N=1016,71% ER+,48% N,n=510,入组标准,: I, II,或,III,期 患者,所有,ER+,患者使用他莫昔芬,中位随访,: 5.5,年,US Oncology 9735:,研究设计,4 x AC q3w,阿霉素,(60 mg/m,2,),环磷酰胺,(600 mg/m,2,),4 x TC q3w,多西他赛,(75 mg/m,2,),环磷酰胺,(600 mg/m,2,),n=506,R,Jones et al.,J Clin Oncol,. 2006;24:5381-87.,USO 9735: TC vs AC,（,7,年）,Jones et al.,Breast Cancer Res Treat,. 2007;106(suppl 1):S5. Abstract 12.,0,12,24,36,48,60,72,84,96,月,0.60,0.65,0.70,0.75,0.80,0.85,0.90,0.95,1.00,无病生存率,P = 0.033,HR =0 .74,TC,AC,81%,75%,86%,80%,0,12,24,36,48,60,72,84,96,月,0.60,0.65,0.70,0.75,0.80,0.85,0.90,0.95,1.00,总生存率,P = 0.032,HR = 0.69,TC,AC,87%,82%,6%,5%,23月,65月随访,HER-2,阳性乳腺癌诊疗专家共识曲妥珠单抗辅助治疗用药时机,推荐,AC - TH,不适合蒽环药物的患者可以用,TCH,也可以完成化疗后,开始,H,辅助治疗已经结束,处于无病状态的患者可以使用,H,( HERA ),小结：紫杉类、蒽环类,联合策略：,T/D+,A/E,+(C),BCIRG 001,CALGB 9741,PACS 04,E2197,序贯策略,：,(F)+,A/E,+C-T,CALGB 9344,NSABP-28,CALGB 9741,PACS 01,TACT,ADEBAR,B2000,非蒽环类：,TC,US 9735,TC,较,AC,的优势仅出现在淋巴结阴性的患者中，淋巴结阳性患者中,TC,不优于,AC,MA. 21,其他有效药物的整合,研究目的,对比,蒽环,/,紫杉,基础上加入,？,治疗中高危,EBC,的疗效及安全性,FinXX: XT-CEX,USO: AC-XT,USO (NO17629):,随机,III,期辅助治疗高危乳腺癌临床试验,年龄,18-70,岁,可手术切除,未发生转移,淋巴结阳性；如果淋巴结阴性：肿瘤大小,2cm,或者,1cm,但,ER/PR,阴性,N=2661,AC(4,个疗程）,A: 60mg/m2,C: 600mg/m2,T(4,个疗程）,T: 100mg/m2,d1,，,q3w,AC(4,个疗程）,A: 60mg/m2,C: 600mg/m2,XT(4,个疗程）,T: 75mg/m2 d1,X: 825mg/m2 bid,d1-14, q3w, p.o.,主要研究终点：无疾病生存（,DFS,；乳腺癌首次复发或死亡）,次要研究终点：,OS,，安全性,注：,ASCO2005,年会议之后，,HER2,阳性乳腺癌患者接受曲妥珠单抗治疗（,102/334HER2,阳性患者接受了曲妥珠单抗治疗）,USO (NO17629),探索性分析：远处,DFS,差异，最终影响总生存,主要分析,DFS*,探索性分析,远处,DFS,发生事件的受试者，,n(%),ACT(n=1304),164(12.6),151(11.6),ACXT(n=1307),140(10.7),123(9.4),P,值,0.125,0.0067,HR 95% CI,0.84 0.671.05,0.80 0.631.02,*DFS,：乳腺癌首次复发或任何原因导致的死亡,远处,DFS,：仅包括全身复发,/,死亡，不包括局部复发,本分析不将新发乳腺癌视为事件（新发乳腺癌划分为同侧,vs,对侧，侵袭性,vs,非侵袭性，,DCIS,）,USO (NO17629),疗效：,总生存显著改善,0,生存率,0,6,12,18,24,30,36,月,42,48,54,60,66,72,78,84,HR 0.68 95% CI: 0,治疗组,AC XT,AC T,92% ACT,94% ACXT,No. left,:,AC T 1,304 1264 1241 1215 1190 1155 1129 1099 1018 860 658 469 305 101 1,AC XT,1307 1250 1234 1213 1182 1155 1129 1109 1042 899 703 520 333 113 5,OShauhnessy et al SABCS 2010,FinXX,设计随机,III,期辅助治疗中高危乳腺癌临床,随机分组,N=,1,500,分层：,中心,淋巴结数量,HER2,状态,D,80,D,80,D,60,D,60,D,60,X,900,X,900,X,900,D,80,C,600,E,75,F,600,C,600,E,75,X,900,X,900,X,900,放疗,AI */,三苯氧胺,治疗,5,年,(ER + ve),放疗,AI */,三苯氧胺,治疗,5,年,(ER + ve),0,3,6,9,12,15,希罗达剂量：,900mg/m,2,bid, d1-14, q21d,* AI,用阿那曲唑,周,FinXX,疗效：希罗达组延长,无复发生存趋势,高危患者,:,T + CEF 745 727 693 662 516 324 94 0,TX + CEX 751 739 717 694 538 319 105 0,92.4%,88.9%,TX / CEX,T / CEF,年,%,0,1,2,3,4,5,100,80,60,40,20,0,86,.6,%,84,.1,%,6,7,HR=0.79(95% CI: 0.60-1.04),FinXX,疗效：希罗达组延长,总生存趋势,高危患者,:,T + CEF 745 738 723 710 561 347 101 0,TX + CEX 751 745 737 722 567 345 110 0,96.1%,95.3%,TX / CEX,T / CEF,年,%,0,1,2,3,4,5,100,80,60,40,20,0,%,%,6,7,HR=0.73(95% CI: 0.52-1.04),FinXX,疗效：希罗达组显著增加乳腺癌相关存活率,高危患者,:,T + CEF 745 738 723 710 561 347 101 0,TX + CEX 751 746 737 722 567 345 110 0,97.3%,96.0%,TX / CEX,T / CEF,年,%,0,1,2,3,4,5,100,80,60,40,20,0,%,%,6,7,HR=0.64(0.44-0.95),不同亚型的化疗分析,早期乳腺癌患者中，约四分之三均为,HER2-,患者分布,Hugh J, et al. J Clin Oncol 2009; 27:1168-1176.,Ellis P, et al. Lancet 2009; 373:1681-1692.,Delbaldo C, et al. Presented at 2011SACBS.,蒽环类辅助化疗的疗效与,HER2,状态有关：,RFS,时间,(,年,),0,20,40,60,80,100,2,4,6,8,10,0,RFS (%),CMF (n=228),CEF (n=237),CEF,vs. CMF,HR=0.91,95%CI=0.71-1.18,P=0.49,HER2-,时间,(,年,),0,20,40,60,80,100,2,4,6,8,10,0,RFS (%),CMF (n=88),CEF (n=75),CEF,vs. CMF,HR=0.52,95%CI=0.34-0.80,P=0.003,HER2+,未经调整的交互检验,HR=1.79 (1.08-2.96);,经过调整的交互检验,HR=1.96 (1.15-3.36);,Pritchard KI, et al. NEJM 2006; 354:2103-2011.,Hugh J, et al. J Clin Oncol 2009; 27:1168-1176.,Ellis P, et al. Lancet 2009; 373:1681-1692.,Delbaldo C, et al. Presented at 2011SACBS.,患者分布,1993例,77,复旦大学肿瘤医院乳腺癌研究所,CALGB 9344,：,ER+/HER2-,亚组，蒽环类基础上联合紫杉类化疗后对,DFS,无明显改善,BCIRG 001,：,ER+/HER2-,亚组，,TAC,与,FAC,的,DFS,相似,(TAC,无获益,),时间,(,年,),0,20,40,60,80,100,1,2,3,4,5,0,无病生存概率,(%),P=0.112,TAC (n=422),FAC (n=405),Hugh J, et al. J Clin Oncol 2009; 27:1168-1176.,BCIRG 001,随访,10,年：,DFS,的亚组分析,Martin M, et al. Presented at 2011SACBS.,总体,经调整,ITT*,0.80 (0.68-0.93),1491,阳性淋巴结数,1-3,0.72 (0.58-0.91),926,阳性淋巴结数,4+,0.87 (0.70-1.09),565,激素受体状态,阴性,0.66 (0.49-0.89),359,激素受体状态,阳性,0.84 (0.70-1.01),1132,HER2/NEU,状态,阴性,0.88 (0.72-1.08),943,HER2/NEU,状态,阳性,0.60 (0.43-0.83),319,HER2/NEU,状态,未知,0.80 (0.54-1.18),229,绝经状态,绝经前,0.69 (0.55-0.86),830,绝经状态,绝经后,0.93 (0.74-1.16),661,0.2,0.6,1.0,1.4,1.8,2.2,HR (95% CI),TAC,更好,FAC,更好,*调整淋巴结状态,激素受体阳性、,HER2,阴性或状态未知亚组，,TAC,的,DFS,与,FAC,相当,PACS 001,：ER+/Ki67-,亚组，与,FEC6,相比，,FEC3-T3,未显著改善预后,时间,(,年,),无病生存概率,(%),0,1,2,3,4,5,0,25,50,75,100,5yDFS: 81 v 84%,5yDFS: 81 v 62%,ER+/Ki67,-,FEC6 (n=266),FEC3,T3,(n=283),ER+/Ki67+,FEC6 (n=63),FEC3,T3,(n=86,),6,Penault-Llorca F, et al. J Clin Oncol 2009; 27:2809-2815.,BCIRG 001,：,ER+/HER2-Ki67-,亚组，,TAC,的,DFS,不优于,FAC,无病生存概率,(%),时间,(,年,),TAC,vs.,FAC,HR=0.70,95%CI=0.27-1.83,P=0.472,FAC (n=107),TAC (n=104),0,1,2,3,4,5,0,25,50,75,100,92.2%,89.3%,Hugh J, et al. J Clin Oncol 2009; 27:1168-1176.,FinXX,疗效：希罗达显著提高三阴性,RFS,0,100,80,60,40,20,0,1,2,3,4,5,6,7,ER+,和,/,或,PR+, HER2-,P,n=1009,ER+,和,/,或,PR+, HER2+,0,100,80,60,40,20,0,1,2,3,4,5,6,7,P,n=163,0,100,80,60,40,20,0,1,2,3,4,5,6,7,P,n=122,ER-/PR-, HER2+,ER-/PR-, HER2-,P,n=202,100,80,60,40,20,0,0,1,2,3,4,5,6,7,T/CEF,TX/CEX,FinXX,疗效：希罗达显著提高三阴性,OS,0,100,80,60,40,20,0,1,2,3,4,5,6,7,ER+,和,/,或,PR+, HER2-,P,n=1009,100,80,60,40,20,0,ER+,和,/,或,PR+, HER2+,0,1,2,3,4,5,6,7,P,n=163,ER-/PR-, HER2-,100,80,60,40,20,0,0,1,2,3,4,5,6,7,P,n=202,P,n=22,ER-/PR-, HER2+,100,80,60,40,20,0,0,1,2,3,4,5,6,7,三阴乳腺癌患者死亡风险下降达,58%,T/CEF,TX/CEX,USO (NO17629),亚组,OS(ITT:,计划内分析）,TNBC,显著改善,0,1-3,4,所有,亚群,白人,黑人,西班牙人,阴性,阳性,阳性,阴性,是,否,偏,AC XT,偏,AC T,所有,范围,阳性淋巴结,种族,ER/PR,状态,HER2,状态,三阴性乳腺癌,0.2 0.4 0.6 1 2 3 4 5 6 10,风险比,N,HR,95% CI,2611,0.68,0.51-0.92,792,1258,561,0.69,0.60,0.77,0.38-1.26,0.37-0.99,0.49-1.23,2127,230,208,0.62,1.81,0.56,0.44-0.87,0.69-4.75,0.21-1.53,943,1668,0.64,0.71,0.44-0.95,0.45-1.11,334,2261,1.00,0.66,0.42-2.35,0.48-0.90,780,1831,0.62,0.72,0.41-0.94,0.48-1.10,OShauhnessy et al SABCS 2010,USO (NO17629),探索性分析：,OS,希罗达降低,ki-67,肿瘤高增殖患者死亡风险,ACT,事件,ACXT,事件,患者，,n,所有,2611,108,75,0.68 0.510.92,Ki-67(,所有患者）,10%,326,7,5,0.72 0.232.27,10%,1194,56,28,0.52 0.330.82,未检测,1076,45,42,0.85 0.561.30,Ki-67 (ER+,HER2-),10%,273,5,4,0.79 0.212.94,10%,570,18,5,0.30 0.110.81,不详,600,17,17,0.92 0.471.81,蒽环类方案是淋巴结阳性,ER+/HER2-,患者辅助化疗的较好方案,Ellis P, et al. Lancet 2009; 373:1681-1692.,Martin M, et al. Presented at 2011SACBS.,0.75 (0.55-1.03),1.05 (0.81-1.36),0.78 (0.52-1.15),1.09 (0.89-1.33),0.97 (0.85-1.11),BCIRG 001,CALGB 9344,GEICAM 9906,TACT(,仅淋巴结阳性,),小计,HR(95% CI),HR(95% CI),0.5,1.0,1.5,紫杉类更好,蒽环类更好,ER+/HER2-,淋巴结阴性ER+，21 gene RS NSABP B14B20,淋巴结,+ ER+,phase III trial S8814 for postmenopausal women with node-positive, ER-positive BC,DFS,OS 和 BCSS,OS 和 BCSS,小结,烷化剂,+,抗代谢类联合,蒽环,+,烷化剂,紫杉,+,蒽环,+,烷化剂,紫杉,+,蒽环,+,烷化剂,+,抗代谢类,具体方案的选择（组合、,个性与共性,）,肿瘤的类型 （临床病理、分子标志）,肿瘤的亚类型（分子标志、基因类型）,