Stotter A, Atkinson E N, Fairston B A, McNeese M, Oswald M J, Balch C M
Department of Surgery, University of Texas M.D. Anderson Cancer Center, Houston.
Ann Surg. 1990 Aug;212(2):166-72. doi: 10.1097/00000658-199008000-00009.
We postulated that locoregional recurrence after limited surgery and radiotherapy for breast cancer might be associated with an additional survival hazard, similar to that of a second primary tumor with the same extent of local and regional disease. Using this hypothesis we examined the likely resultant effect on survival. Our calculations indicated that no statistically significant survival deficit due to such recurrence would be detectable until a randomized controlled trial comparing breast conservation with mastectomy had monitored more than 10,000 patients for more than 10 years. A simple mathematical model predicted 5-year survival rates in a cohort of patients treated with breast conservation of 75%, compared to 83% in those without locoregional recurrence. From the date of locoregional recurrence, a 61% 5-year survival rate was predicted, compared to 83% if no hazard was associated with locoregional recurrence. These predictions were compared with the actuarial survival rates of 499 patients with unilateral breast cancer, 49 of whom had developed locoregional recurrence. From the date of initial treatment, the 5-year survival rate of those whose disease recurred was 79%, compared to 88% for those without locoregional recurrence (p = 0.19). The actuarial 5-year survival rate from the date of locoregional recurrence was 63%. The similarity between the patient data and the predictions of the mathematical model indicates that locoregional failure after breast conservation therapy may result in reduced survival. The lack of a significant survival deficit in our cohort or in controlled trials comparing breast conservation therapy with mastectomy is compatible to the small size of the overall effect.
我们推测，乳腺癌在接受有限手术和放疗后的局部区域复发可能与额外的生存风险相关，类似于具有相同局部和区域疾病范围的第二原发性肿瘤。基于这一假设，我们研究了其对生存可能产生的影响。我们的计算表明，在一项比较保乳手术和乳房切除术的随机对照试验对超过10000名患者进行超过10年的监测之前，因这种复发导致的生存缺陷在统计学上无显著差异。一个简单的数学模型预测，一组接受保乳治疗的患者5年生存率为75%，而无局部区域复发的患者为83%。从局部区域复发之日起，预测5年生存率为61%，而如果局部区域复发无风险，则为83%。将这些预测结果与499名单侧乳腺癌患者的精算生存率进行比较，其中49人发生了局部区域复发。从初始治疗之日起，疾病复发患者的5年生存率为79%，无局部区域复发患者为88%（p = 0.19）。从局部区域复发之日起的精算5年生存率为63%。患者数据与数学模型预测结果之间的相似性表明，保乳治疗后的局部区域失败可能导致生存率降低。在我们的队列中或在比较保乳治疗与乳房切除术的对照试验中缺乏显著的生存缺陷，这与总体效应的规模较小是相符的。
