Kleeberg Ulrich R, Fink Michael, Tessen Hans-Werner, Nennecke Alice, Hentschel Stefan, Bartels Stefan
Hämatologisch-Onkologische Praxis Altona, Hamburg, Germany.
Onkologie. 2013;36(6):348-56. doi: 10.1159/000351253. Epub 2013 May 21.
Adjuvant treatment concepts have improved the 10-year cure rate of breast and colon cancer, but new treatments for metastatic disease have yielded only incremental benefit. If treatments for disseminated cancer were actually prolonging life rather than only increasing remission rates, this effect should have been documented over the last 30+ years. However, published data concerning advances in treatment for disseminated cancer have been contradictory.
To add data-based information, we analyzed 2 sources: a regional population-based cancer registry (Hamburgisches Krebsregister, HKR), and a research cancer registry (Projektgruppe Internistische Onkologie, PIO). We compared the survival of several thousand patients with metastatic disease who received treatment only after dissemination with that of patients who received initial adjuvant therapy.
After adjuvant treatment, survival in patients with disseminated breast cancer is up to a third shorter than that of patients without adjuvant therapy.
In accordance with published evidence, we conclude that ineffective adjuvant treatment shortens survival after documentation of metastatic disease. This is probably due to the elimination of chemo-sensitive tumor cells or to the induction of resistance in remaining micrometatases. This negative effect on survival after dissemination has been shown clearly for breast cancer and is also probable for cancer of the colon and other sites.
辅助治疗理念提高了乳腺癌和结肠癌的10年治愈率，但针对转移性疾病的新治疗方法仅带来了有限的益处。如果针对播散性癌症的治疗实际上是在延长生命而非仅仅提高缓解率，那么这种效果在过去30多年里应该已有记录。然而，关于播散性癌症治疗进展的已发表数据相互矛盾。
为补充基于数据的信息，我们分析了两个来源：一个基于地区人群的癌症登记处（汉堡癌症登记处，HKR）和一个研究性癌症登记处（内科肿瘤学项目组，PIO）。我们比较了数千名仅在发生播散后才接受治疗的转移性疾病患者与接受初始辅助治疗患者的生存率。
辅助治疗后，播散性乳腺癌患者的生存期比未接受辅助治疗的患者短多达三分之一。
根据已发表的证据，我们得出结论，无效的辅助治疗会缩短转移性疾病确诊后的生存期。这可能是由于清除了化疗敏感的肿瘤细胞或诱导了残留微转移灶的耐药性。这种对播散后生存期的负面影响在乳腺癌中已得到明确证实，在结肠癌和其他部位的癌症中也很可能存在。
