Cantonal Hospital Winterthur, Department of Gynecology and Obstetrics, Brauerstrasse 15, CH-8401 Winterthur, Switzerland; Breast Center "SenoSuisse", Brauerstrasse 15, CH-8401 Winterthur, Switzerland.
Eur J Surg Oncol. 2013 Nov;39(11):1192-8. doi: 10.1016/j.ejso.2013.08.015. Epub 2013 Sep 10.
This study evaluates the frequency of and indications for disease-related surgical procedures in the palliative breast cancer (BC) situation.
PATIENTS & METHODS: Based on a cohort of women who were treated for newly diagnosed BC during a 20-year period (1990-2009), we analyzed 340 patients who developed distant metastatic disease (DMD) until 2011 and died (i.e. still ongoing palliative disease courses were not included).
One hundred and twenty-seven surgical procedures were performed in 100 patients (29.4% of all patients with metastatic disease). The most common site for surgery was breast (n = 60, 47.2%). The primary tumor was removed at first diagnosis of DMD in 43 patients (33.9%); sixteen operations (12.6%) were performed for local recurrence. In 37 patients, 50 surgical procedures (39.4%) were necessary to stabilize osseous structures due to metastases. Procedures were rarely performed on other common metastatic sites: lung: n = 1 (0.8%); liver: n = 1 (0.8%), brain: n = 4 (3.1%). When excluding surgery for primary breast tumors at initial diagnosis of DMD from analysis, 34 of 84 surgeries (40.4%) were performed in the first third of survival follow-up (i.e. period of metastatic disease survival); operations in the last two-thirds each totaled 29.8% (n = 25). The median survival after surgery was 16 months (range: 0.5-89 months).
In a cohort of BC patients who had primary or developed secondary DMD, nearly one third of the patients received disease-related surgical procedures during their palliative disease course. This high rate of operations shows that surgery has a clearly established role in the palliative therapy concept.
本研究评估了在姑息性乳腺癌（BC）情况下与疾病相关的手术的频率和适应证。
基于在 20 年间（1990-2009 年）接受新诊断的 BC 治疗的女性队列，我们分析了 340 名在 2011 年之前发生远处转移疾病（DMD）并死亡的患者（即不包括仍在进行的姑息性疾病过程）。
在 100 名患有转移性疾病的患者中进行了 127 次手术（所有转移性疾病患者的 29.4%）。最常见的手术部位是乳房（n=60，47.2%）。在 43 名患者中（33.9%），在首次诊断 DMD 时即切除了原发肿瘤；16 例手术（12.6%）用于局部复发。在 37 名患者中，由于转移，50 例手术（39.4%）用于稳定骨骼结构。很少在其他常见的转移性部位进行手术：肺：n=1（0.8%）；肝：n=1（0.8%），脑：n=4（3.1%）。当从分析中排除在初始 DMD 诊断时切除原发性乳腺癌的手术时，84 次手术中的 34 次（40.4%）在生存随访的前三分之一（即转移性疾病生存期）进行；后两个三分之一各进行了 29.8%（n=25）。手术后的中位生存时间为 16 个月（范围：0.5-89 个月）。
在一组患有原发性或继发性 DMD 的 BC 患者中，近三分之一的患者在姑息性疾病过程中接受了与疾病相关的手术。这种高手术率表明手术在姑息治疗概念中具有明确的作用。
