Wagman L D, Sanders R D, Terz J J, Beatty J D, Kokal W A, Riihimaki D U
Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, California 91010.
Surg Gynecol Obstet. 1991 Mar;172(3):191-6.
Specific postoperative tests used to diagnose recurrent carcinoma of the breast were evaluated for their ability to have an impact on the over-all course of the disease. Sixty-four patients with recurrent or new contralateral primary disease were divided into two groups based on the method of diagnosis. Those patients with a new complaint at an interval between scheduled follow-up visits and who went on to have tests to document a recurrence were categorized as interval follow-up. Those who were seen at a prearranged regular follow-up period and received tests as recommended by the attending physician or surgeon and had a documented recurrence were classified as routine follow-up. Thirteen patients presented with new contralateral primary disease and 51 with metastatic disease (16, bone; 13, lung; 11, local; three, liver, and eight, multiple). The median time to discovery of recurrence from the primary treatment was 29 and 28 months for the interval and routine groups, respectively. Ninety per cent of the failures occurred by 53 months. The survival time after recurrence was significantly greater in those patients diagnosed routinely (p = 0.003). However, the over-all survival time (from primary therapy to death) was only significantly improved for the routine group when the contralateral new primary diseases were included (p = 0.009). The method of diagnosis of a contralateral primary carcinoma was physical examination and mammogram. Strong recommendations for follow-up testing can be limited to mammogram and physical examination.
对用于诊断复发性乳腺癌的特定术后检查进行了评估，以确定其对疾病总体进程产生影响的能力。64例患有复发性或对侧新发原发性疾病的患者根据诊断方法分为两组。那些在预定随访期间出现新症状并继续进行检查以证实复发的患者被归类为间隔随访。那些在预先安排的定期随访期间就诊并按照主治医师或外科医生的建议接受检查且有复发记录的患者被归类为常规随访。13例患者出现对侧新发原发性疾病，51例出现转移性疾病（16例骨转移；13例肺转移；11例局部转移；3例肝转移；8例多处转移）。间隔随访组和常规随访组从初次治疗到发现复发的中位时间分别为29个月和28个月。90%的复发发生在53个月内。常规诊断的患者复发后的生存时间显著更长（p = 0.003）。然而，当纳入对侧新发原发性疾病时，仅常规随访组的总体生存时间（从初次治疗到死亡）有显著改善（p = 0.009）。对侧原发性癌的诊断方法是体格检查和乳房X线摄影。对随访检查的强烈建议可仅限于乳房X线摄影和体格检查。
