Weiss M C, Fowble B L, Solin L J, Yeh I T, Schultz D J
Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia.
Int J Radiat Oncol Biol Phys. 1992;23(5):941-7. doi: 10.1016/0360-3016(92)90898-r.
Between 1977 and 1986, 879 patients with Stage I and II breast cancer underwent excisional biopsy, axillary dissection, and radiation. Median follow-up was 61 months (range 2-159 months). The patients were divided into seven groups based on histologic subtype: (a) 368 patients with both infiltrating and intraductal ductal carcinoma, (b) 389 infiltrating ductal carcinoma, (c) 41 infiltrating lobular carcinoma, (d) 23 combined infiltrating ductal and lobular carcinoma, (e) 28 medullary carcinoma, (f) 12 colloid carcinomas, and (g) 18 tubular carcinomas. Significant differences in clinical T status, pathologic nodal involvement, administration of chemotherapy, estrogen receptor positivity, progesterone receptor positivity, and age were observed between some histologic subgroups. Tubular and colloid carcinomas were more likely to present with T1 lesions, hormone receptor positivity, and node negative status than the other histologic subtypes. Most medullary carcinomas were hormone receptor negative and were younger than 50 years old. Infiltrating lobular carcinoma patients were more frequently lymph node negative, older, node negative, and estrogen receptor positive compared to the other groups (except for tubular and colloid patients). Differences in the administration of chemotherapy primarily reflected differences in lymph node involvement. Location of the tumor in the breast and menopausal status did not correlate with histologic subtype. There were no significant differences in 5-year actuarial overall survival, cause-specific survival, or relapse-free survival between the histologic categories. In addition, patterns of first failure were not significantly different among the histologic groups in terms of local-only first failure, any local component of first failure, regional-only first failure, or any regional component of first failure. There was, however, a difference among the seven groups in distant metastasis-only at first failure with invasive ductal carcinomas having the highest rate. Despite this difference, histologic subtype had no impact on survival. The site of in-breast failure relative to the location of the original tumor was not significantly different between groups. The histologic subtype of invasive breast cancer is not an independent risk factor in predicting survival or pattern of failure. Conservative surgery and radiation therapy is effective treatment of ductal, lobular, medullary, colloid, and tubular invasive breast cancer.
1977年至1986年间，879例I期和II期乳腺癌患者接受了切除活检、腋窝清扫及放疗。中位随访时间为61个月（范围2 - 159个月）。根据组织学亚型将患者分为七组：(a) 368例浸润性和导管内癌患者，(b) 389例浸润性导管癌患者，(c) 41例浸润性小叶癌患者，(d) 23例浸润性导管癌和小叶癌合并患者，(e) 28例髓样癌患者，(f) 12例黏液癌患者，(g) 18例管状癌患者。在一些组织学亚组之间观察到临床T分期、病理淋巴结受累情况、化疗应用、雌激素受体阳性、孕激素受体阳性及年龄方面存在显著差异。与其他组织学亚型相比，管状癌和黏液癌更易表现为T1病变、激素受体阳性及淋巴结阴性状态。大多数髓样癌激素受体阴性，且年龄小于50岁。与其他组（管状癌和黏液癌患者除外）相比，浸润性小叶癌患者淋巴结阴性、年龄较大、淋巴结阴性且雌激素受体阳性更为常见。化疗应用的差异主要反映在淋巴结受累情况的差异上。肿瘤在乳腺内的位置及绝经状态与组织学亚型无关。各组织学类别之间的5年精算总生存率、病因特异性生存率或无复发生存率无显著差异。此外，在仅局部首次失败、首次失败的任何局部成分、仅区域首次失败或首次失败的任何区域成分方面，各组织学组之间首次失败模式无显著差异。然而，七组之间在首次失败时仅远处转移方面存在差异，浸润性导管癌发生率最高。尽管存在这种差异，但组织学亚型对生存率无影响。各组之间乳腺内失败部位相对于原发肿瘤位置无显著差异。浸润性乳腺癌的组织学亚型不是预测生存率或失败模式的独立危险因素。保乳手术和放疗是导管癌、小叶癌、髓样癌、黏液癌及管状浸润性乳腺癌的有效治疗方法。
