Rapiti Elisabetta, Fioretta Gerald, Vlastos Georges, Kurtz John, Schäfer Peter, Sappino André Pascal, Spiliopoulos Anastase, Renella Raffaele, Neyroud-Caspar Isabelle, Bouchardy Christine
Geneva Cancer Registry, Institute for Social and Preventive Medicine, University of Geneva, Bd de la Cluse 55, CH-1205 Geneva, Switzerland.
Radiother Oncol. 2003 Dec;69(3):277-84. doi: 10.1016/j.radonc.2003.09.003.
Early-stage breast cancer is increasing and consequently the use of breast-conserving surgery (BCS). We examined the effect of mastectomy and BCS on overall and breast cancer survival in routine health care in Geneva, Switzerland.
We included all stage I breast cancers treated by surgery (n=1046) recorded at the Geneva Cancer Registry between 1988 and 1999. The effect of treatment type was evaluated by Cox models, which accounted for confounders.
Overall, 780 (75%) women had BCS with radiotherapy, 57 (5%) BCS alone and 209 (20%) mastectomy. The overall 10-year survival was 86, 56, and 72%, respectively. The effect of BCS with radiotherapy was similar to that of mastectomy for both breast cancer mortality (adjusted hazard ratio (HR), 0.67; 95%CI, 0.31-1.38) and other causes of mortality (HR, 0.79; 95%CI, 0.49-1.28). Women with BCS alone had higher mortality from breast cancer (HR, 3.95; 95%CI, 1.59-9.84).
This retrospective study shows that BCS plus radiotherapy is the predominant treatment in routine practice for stage I breast cancer in Geneva, with the same effect on survival as mastectomy. In this data set the addition of radiotherapy to BCS substantially reduces mortality from breast cancer without increasing other causes of mortality after 10 years of follow-up.
早期乳腺癌的发病率在上升，因此保乳手术（BCS）的应用也在增加。我们研究了在瑞士日内瓦的常规医疗保健中，乳房切除术和保乳手术对总体生存率和乳腺癌生存率的影响。
我们纳入了1988年至1999年在日内瓦癌症登记处记录的所有接受手术治疗的I期乳腺癌患者（n = 1046）。通过Cox模型评估治疗类型的效果，该模型考虑了混杂因素。
总体而言，780名（75%）女性接受了保乳手术加放疗，57名（5%）仅接受了保乳手术，209名（20%）接受了乳房切除术。总体10年生存率分别为86%、56%和72%。对于乳腺癌死亡率（调整后的风险比（HR），0.67；95%置信区间，0.31 - 1.38）和其他死亡原因（HR，0.79；95%置信区间，0.49 - 1.28），保乳手术加放疗的效果与乳房切除术相似。仅接受保乳手术的女性乳腺癌死亡率更高（HR，3.95；95%置信区间，1.59 - 9.84）。
这项回顾性研究表明，保乳手术加放疗是日内瓦I期乳腺癌常规治疗中的主要治疗方法，对生存率的影响与乳房切除术相同。在这个数据集中，保乳手术加放疗在10年随访后可大幅降低乳腺癌死亡率，且不会增加其他死亡原因。
