Fowble B, Solin L J, Schultz D J, Weiss M C
Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia.
Int J Radiat Oncol Biol Phys. 1992;23(5):933-9. doi: 10.1016/0360-3016(92)90897-q.
Between 1977 and 1986, 886 pts with Stage I and II breast cancer underwent excisional biopsy, axillary dissection and radiation. Median follow-up was 5 years (range 2 months-13 years). The patients were divided into four groups according to the primary tumor location: 1) outer (495 patients), 2) inner (202 patients), 3) central (119 patients), and 4) subareolar (70 patients). Subareolar tumors were defined as those immediately beneath the nipple-areolar complex or within 2 cm of the areolar margin. The comparability of the groups was assed in terms of clinical T stage, patient age, histology, final pathologic margin status, estrogen and progesterone receptor status, pathologic nodal status, and use of adjuvant chemotherapy. There were no significant differences among the four groups in the distribution of these factors except for the pathologic nodal status (outer 38% positive nodes, inner 24%, central 23%, subareolar 31%) p = .0004. There were no significant differences in 5 year actuarial overall survival (91% vs 86% vs 92% vs 91%, p = .34), relapse-free (75% vs 74% vs 80% vs 79%, p = .77), or NED survival (82% vs 78% vs 87% vs 84%, p = .29) for the four groups. A separate analysis for pathologic node negative and node positive patients revealed similar findings. For node-negative patients, the 5 year actuarial overall survival was 93% vs 88% vs 94% vs 91% (p = .20), the relapse-free survival was 78% vs 76% vs 82% vs 79% (p = .49), and the NED survival was 86% vs 81% vs 88% vs 86% (p = .46). For node-positive patients, the 5 year actuarial overall survival was 87% vs 82% vs 84% vs 90% (p = .59), relapse-free survival was 69% vs 66% vs 77% vs 80% (p = .78), and NED survival was 75% vs 68% vs 85% vs 80% (p = .66). Patterns of first failure were also not significantly different among the four groups: local only first failure (7% vs 4% vs 5% vs 8%, p = .49), any local first failure, i.e., +/- simultaneous distant metastases (8% vs 5% vs 5% vs 9%, p = .61), regional only (2% vs 1% 1% vs 0%, p = .65), any regional (4% vs 3% vs 3% vs 3%), or distant metastases (11% vs 17% vs 9% vs 10%, p = .16). A separate analysis of node negative and node positive patients revealed similar findings.(ABSTRACT TRUNCATED AT 400 WORDS)
1977年至1986年间，886例I期和II期乳腺癌患者接受了切除活检、腋窝淋巴结清扫及放疗。中位随访时间为5年（范围2个月至13年）。根据原发肿瘤位置，患者被分为四组：1）外侧（495例患者），2）内侧（202例患者），3）中央（119例患者），4）乳晕下（70例患者）。乳晕下肿瘤定义为紧邻乳头-乳晕复合体下方或距乳晕边缘2 cm以内的肿瘤。根据临床T分期、患者年龄、组织学、最终病理切缘状态、雌激素和孕激素受体状态、病理淋巴结状态及辅助化疗的使用情况评估各组的可比性。除病理淋巴结状态外（外侧38%淋巴结阳性，内侧24%，中央23%，乳晕下31%），p = 0.0004，这四个组在这些因素的分布上无显著差异。四组的5年精算总生存率（91%对86%对92%对91%，p = 0.34）、无复发生存率（75%对74%对80%对79%，p = 0.77）或无疾病生存（NED）率（82%对78%对87%对84%，p = 0.29）均无显著差异。对病理淋巴结阴性和阳性患者的单独分析显示了类似的结果。对于淋巴结阴性患者，5年精算总生存率为93%对88%对94%对91%（p = 0.20），无复发生存率为78%对76%对82%对79%（p = 0.49），NED生存率为86%对81%对88%对86%（p = 0.46）。对于淋巴结阳性患者，5年精算总生存率为87%对82%对84%对90%（p = 0.59），无复发生存率为69%对66%对77%对80%（p = 0.78），NED生存率为75%对68%对85%对80%（p = 0.66）。四组首次失败的模式也无显著差异：仅局部首次失败（7%对4%对5%对8%，p = 0.49），任何局部首次失败，即伴有或不伴有同时远处转移（8%对5%对5%对9%，p = 0.61），仅区域转移（2%对1%对1%对0%，p = 0.65）；任何区域转移（4%对3%对3%对3%），或远处转移（11%对17%对9%对10%，p = 0.16）。对淋巴结阴性和阳性患者的单独分析显示了类似的结果。（摘要截短至400字）
