van der Hage J A, Putter H, Bonnema J, Bartelink H, Therasse P, van de Velde C J H
Department of Surgery, D6-43, Leiden University Medical Center, PO box 9600, 2300 RC Leiden, The Netherlands.
Eur J Cancer. 2003 Oct;39(15):2192-9. doi: 10.1016/s0959-8049(03)00572-0.
Although adequate locoregional treatment improves local and regional control in early-stage breast cancer, uncertainty still exists about the role of locoregional therapy with respect to survival. To study the impact of surgery and radiotherapy on locoregional control and survival, we combined the data of three European Organisation for Research and Treatment of Cancer (EORTC) Breast Cancer Group trials including early-stage breast cancer patients with long-term follow-up. Risk ratios (RR) were estimated for locoregional recurrence and overall survival using Cox regression models. All analyses were adjusted for tumour size, nodal status, age, adjuvant radiotherapy, adjuvant chemotherapy and trial. The combined data-set consisted of 3648 patients. The median follow-up period was 11 years. 5.9% of the patients who underwent mastectomy and 10.8% of the patients who underwent breast-conserving therapy had a locoregional recurrence (P<0.0001). The risk of death after breast-conserving therapy was similar compared with mastectomy (RR 1.07, P=0.37). Adjuvant radiotherapy after mastectomy was associated with a lower risk for locoregional recurrence (RR 0.43, P<0.001) and death (RR 0.73, P=0.001). Patients with 1-3 positive nodes benefited the most from radiotherapy after mastectomy. Breast-conserving therapy was associated with an impaired locoregional control. However, breast-conserving therapy was not associated with a worse overall survival. Adjuvant radiotherapy in mastectomised patients was associated with both a significantly superior locoregional control and overall survival. The effect of adjuvant radiotherapy was most profound in patients who had 1-3 positive nodes.
尽管充分的局部区域治疗可改善早期乳腺癌的局部和区域控制，但局部区域治疗对生存的作用仍存在不确定性。为研究手术和放疗对局部区域控制及生存的影响，我们合并了三项欧洲癌症研究与治疗组织（EORTC）乳腺癌小组试验的数据，这些试验纳入了接受长期随访的早期乳腺癌患者。使用Cox回归模型估计局部区域复发和总生存的风险比（RR）。所有分析均针对肿瘤大小、淋巴结状态、年龄、辅助放疗、辅助化疗和试验进行了校正。合并数据集包含3648例患者。中位随访期为11年。接受乳房切除术的患者中有5.9%发生局部区域复发，接受保乳治疗的患者中有10.8%发生局部区域复发（P<0.0001）。与乳房切除术相比，保乳治疗后的死亡风险相似（RR 1.07，P=0.37）。乳房切除术后辅助放疗与较低的局部区域复发风险（RR 0.43，P<0.001）和死亡风险（RR 0.73，P=0.001）相关。有1-3枚阳性淋巴结的患者从乳房切除术后放疗中获益最大。保乳治疗与局部区域控制受损相关。然而，保乳治疗与较差的总生存无关。乳房切除术后患者的辅助放疗与显著更好的局部区域控制和总生存均相关。辅助放疗的效果在有1-3枚阳性淋巴结的患者中最为显著。
