Combined Breast Clinic, St. George's Hospital, London SW17 0QT, UK.
Eur J Surg Oncol. 2011 Sep;37(9):754-7. doi: 10.1016/j.ejso.2011.06.011. Epub 2011 Jul 18.
A final review of a historical trial commenced in 1982 comprising 200 patients aged 70 or over with operable breast cancer randomised to surgery or tamoxifen with crossover on recurrence has shown that at 21-28 years follow-up,all have died from verified causes. 43 in the surgical arm and 40 in the Tamoxifen arm died of breast cancer (41.5% in total). 117 patients (58.5%) died of other verified causes unrelated to breast cancer. These patients in effect achieved a cure from breast cancer. The survival curves for both those treated by surgery or Tamoxifen are similar as are the associated curves comparing deaths from breast cancer and other causes. However although 50% of deaths from breast cancer occurred within the first five years of follow-up, further deaths from breast cancer occurred up to 25 years later. Thus at long term follow-up in a highly selected and favourable group of patients recurrence and death from breast cancer still occurred. This confirms the view that at no time in the post treatment period can one state that any patient is cured of breast cancer. However with favourable patient presentation and optimal current treatment there is a high probability that in a significant number of patients a personal cure will be achieved as described by Brinkley and Haybittle.
对 1982 年开始的一项历史性试验进行了最终回顾，该试验纳入了 200 名年龄在 70 岁以上的可手术乳腺癌患者，随机分为手术组或他莫昔芬组，复发时可交叉治疗。结果显示，21-28 年随访后，所有患者均因证实的原因死亡。手术组 43 例，他莫昔芬组 40 例死于乳腺癌（总病死率为 41.5%）。117 例（58.5%）患者死于其他与乳腺癌无关的经证实病因。这些患者实际上已经治愈了乳腺癌。手术组和他莫昔芬组的生存曲线相似，乳腺癌和其他病因所致死亡的相关曲线也相似。然而，尽管 50%的乳腺癌死亡发生在随访的前 5 年内，但仍有乳腺癌死亡发生在 25 年以后。因此，在高度选择和有利的患者群体中进行长期随访时，仍会发生乳腺癌的复发和死亡。这证实了这样一种观点，即在治疗后任何时候，都不能说任何患者已经治愈了乳腺癌。然而，对于具有良好临床表现和最佳现有治疗的患者，如 Brinkley 和 Haybittle 所述，在很大一部分患者中，极有可能实现个人治愈。
