Groenendijk R P, Bult P, Tewarie L, Peer P G, van der Sluis R F, Ruers T J, Wobbes T
Department of Surgery, University Hospital Nijmegen Sint Radboud, Nijmegen, The Netherlands.
Br J Cancer. 2000 Jan;82(2):381-4. doi: 10.1054/bjoc.1999.0930.
We know that screening for breast cancer leads to detection of smaller tumours with less lymph node metastases. Could it be possible that the decrease in mortality after screening is not only caused by this earlier stage, but also by a different mitotic activity index (MAI) of the tumours that are detected by screening? Is MAI a prognostic factor for recurrence-free survival? A retrospective study was carried out of 387 patients with breast cancer, treated at the University Hospital Nijmegen between January 1992 and September 1997. Ninety patients had screen-detected breast cancer, 297 patients had breast cancers detected outside the screening programme. The MAI, other prognostic factors and recurrence-free survival were determined. In non-screen-detected tumours the MAI is twice as high as in screen-detected tumours, even after correction for age took place. The MAI correlated well with other tumour characteristics. The MAI in itself is a prognostic factor for recurrence-free survival. Favourable outcome in screen detected breast cancer is not entirely caused by detecting cancer in early stages: quantitative features such as the MAI indicate a less malignant character of screen detected breast cancer. The MAI is an independent prognostic factor for recurrence-free survival.
我们知道，乳腺癌筛查能检测出更小且淋巴结转移较少的肿瘤。筛查后死亡率的降低是否不仅是因为癌症处于更早阶段，还可能是由于筛查检测出的肿瘤具有不同的有丝分裂活性指数（MAI）呢？MAI是否是无复发生存的预后因素呢？对1992年1月至1997年9月在奈梅亨大学医院接受治疗的387例乳腺癌患者进行了一项回顾性研究。90例患者的乳腺癌是通过筛查发现的，297例患者的乳腺癌是在筛查项目之外发现的。测定了MAI、其他预后因素以及无复发生存情况。即使在对年龄进行校正之后，未通过筛查发现的肿瘤的MAI仍比通过筛查发现的肿瘤高出两倍。MAI与其他肿瘤特征密切相关。MAI本身就是无复发生存的一个预后因素。筛查发现的乳腺癌的良好预后并不完全是因为在早期阶段发现了癌症：诸如MAI这样的定量特征表明筛查发现的乳腺癌恶性程度较低。MAI是无复发生存的一个独立预后因素。
