Jakesz Raimund, Samonigg Hellmut, Gnant Michael, Kubista Ernst, Depisch Dieter, Kolb Roland, Mlineritsch Brigitte, Mischinger Hans-Jörg, Menzel Rainer-Christian, Steindorfer Peter, Kwasny Werner, Tausch Christoph, Stierer Michael, Taucher Susanne, Seifert Michael, Hausmaninger Hubert
Department of Surgery, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Ann Surg. 2003 Apr;237(4):556-64. doi: 10.1097/01.SLA.0000059990.43981.4E.
To confirm evidence that breast-conserving treatment (BCT) does not impair the prognosis in breast cancer patients as compared to mastectomy and to argue that it be regarded as the treatment of choice in stage I and II disease.
Scientifically, survival rates in breast cancer have been shown to be stage-dependent, but independent of the extent of surgical breast tissue removal, as long as the resection margins are free of tumor infiltration.
Between 1984 and 1997, six different trials conducted by the Austrian Breast & Colorectal Cancer Study Group accrued a total of 4,259 women with hormone-responsive disease. The authors selected and compared three patient groups (n = 3,316) according to pathologic stage, age, and the surgical procedure applied.
Over this interval, the BCT rate in the premenopausal node-positive subgroup experienced a highly significant increase from 27.2% to 73.2% overall. In the group of postmenopausal node-negative patients, the BCT rate grew significantly by 37.3% to 77.3% in total. With an overall BCT rate growing from 22.5% to 56.8% in postmenopausal node-positive women, those presenting with T1 tumors saw a significant increase from 35.1% to 65.9%. Mortality and local recurrence rates proved stable or even decreased considerably over time and in all subgroups.
The presented outcome of BCT rates, significantly improved over this 16-year period and in no way counterbalanced by higher local recurrence or death rates, reflects an excellent example of surgical quality control. BCT can safely be regarded as the standard of therapy for T1 and increasingly for T2 disease. Especially in multi-institutional adjuvant breast cancer trials, the highest priority should be given to breast-conserving procedures.
证实与乳房切除术相比，保乳治疗（BCT）不会损害乳腺癌患者的预后，并主张将其视为I期和II期疾病的首选治疗方法。
从科学角度来看，乳腺癌的生存率已显示出与分期有关，但与手术切除乳腺组织的范围无关，只要切缘无肿瘤浸润。
1984年至1997年间，奥地利乳腺癌和结直肠癌研究组进行了六项不同试验，共纳入4259例激素反应性疾病女性患者。作者根据病理分期、年龄和所采用的手术方法选择并比较了三组患者（n = 3316）。
在此期间，绝经前淋巴结阳性亚组的保乳治疗率总体上从27.2%显著提高到73.2%。在绝经后淋巴结阴性患者组中，保乳治疗率总共显著提高了37.3%，达到77.3%。绝经后淋巴结阳性女性的总体保乳治疗率从22.5%提高到56.8%，其中T1肿瘤患者从35.1%显著提高到65.9%。随着时间推移，所有亚组的死亡率和局部复发率均保持稳定甚至显著下降。
保乳治疗率在这16年期间显著提高，且未被更高的局部复发率或死亡率抵消，这是手术质量控制的一个出色范例。保乳治疗可安全地被视为T1期疾病以及越来越多的T2期疾病的治疗标准。特别是在多机构辅助乳腺癌试验中，应将保乳手术置于最高优先级。
