Karlsson P, Holmberg E, Samuelsson A, Johansson K A, Wallgren A
Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden.
Eur J Cancer. 1998 Dec;34(13):2068-75. doi: 10.1016/s0959-8049(98)00319-0.
The aim was to quantify the risk of post-treatment sarcoma in breast cancer patients. All 122,991 women with a breast cancer from 1958 to 1992 in the Swedish Cancer Register were followed up for soft tissue sarcomas and 116 were found, giving a standardised incidence ratio of 1.9 (95% CI 1.5-2.2). The absolute risk was 1.3 per 10(4) person-years. The sarcomas were located in the breast region or on the ipsilateral arm in 63% (67/106). There were 40 angiosarcomas and 76 sarcomas of other types. In a case-control study, angiosarcoma correlated significantly with lymphoedema of the arm, odds ratio (OR) 9.5 (95% CI 3.2-28.0), but no correlation with radiotherapy was observed. For other types of sarcoma there was a correlation with the integral dose. The dose-response relationship indicated that the risk increased linearly with the integral dose to 150-200 J and stabilised at higher energies. The OR was 2.4 (95% CI 1.4-4.2) for an energy of 50 J, approximately corresponding to the radiation of the breast after breast-conserving surgery. Thus, only oedema of the arm correlated with angiosarcoma, but for other types of sarcoma the integral dose of radiotherapy was a predictor of the risk.
目的是量化乳腺癌患者治疗后发生肉瘤的风险。对瑞典癌症登记处1958年至1992年间的所有122,991例乳腺癌女性患者进行软组织肉瘤随访，发现116例，标准化发病率比为1.9（95%可信区间1.5 - 2.2）。绝对风险为每10⁴人年1.3例。63%（67/106）的肉瘤位于乳腺区域或同侧手臂。其中有40例血管肉瘤和76例其他类型的肉瘤。在一项病例对照研究中，血管肉瘤与手臂淋巴水肿显著相关，比值比（OR）为9.5（95%可信区间3.2 - 28.0），但未观察到与放疗的相关性。对于其他类型的肉瘤，与积分剂量相关。剂量反应关系表明，风险随积分剂量线性增加至150 - 200焦耳，并在更高能量时稳定。能量为50焦耳时的OR为2.4（95%可信区间1.4 - 4.2），大约相当于保乳手术后乳腺的辐射量。因此，只有手臂水肿与血管肉瘤相关，但对于其他类型的肉瘤，放疗的积分剂量是风险的一个预测指标。
