Maddox W A, Carpenter J T, Laws H T, Soong S J, Cloud G, Balch C M, Urist M M
Department of Surgery, University of Alabama, Birmingham 35294.
Arch Surg. 1987 Nov;122(11):1317-20. doi: 10.1001/archsurg.1987.01400230103018.
This study (Alabama Breast Cancer Project) reports the ten-year surgical results of a prospective randomized trial comparing Halsted radical mastectomy (RM) with modified radical mastectomy (MRM) for breast cancer. We entered 311 patients in the study between 1975 and 1978. Patients with histologically positive axillary lymph nodes were randomized after operation to receive melphalan or intermittent intravenous cyclophosphamide, methotrexate, and fluorouracil for one year. After a median follow-up of ten years, there was no significant difference in the survival of the two groups (RM, 71%; MRM, 64%). Local recurrence after RM was significantly lower than after MRM. A subset of patients with more advanced cancers (T3 and T2 with clinically positive axillary nodes) experienced significantly better survival at ten years following RM compared with MRM (59% vs 38%, respectively). These results indicate that overall survival is similar for patients treated by either RM or MRM. However, there is subset of patients with more advanced cancers whose ultimate survival can be favorably influenced by RM.
本研究（阿拉巴马乳腺癌项目）报告了一项前瞻性随机试验的十年手术结果，该试验比较了乳腺癌根治性乳房切除术（RM）与改良根治性乳房切除术（MRM）。1975年至1978年间，我们将311名患者纳入该研究。组织学检查腋窝淋巴结阳性的患者术后随机接受美法仑或间歇性静脉注射环磷酰胺、甲氨蝶呤和氟尿嘧啶治疗一年。经过十年的中位随访，两组患者的生存率无显著差异（RM组为71%，MRM组为64%）。RM术后的局部复发率显著低于MRM术后。与MRM相比，一部分癌症进展较严重的患者（T3期和伴有临床腋窝淋巴结阳性的T2期）在接受RM治疗十年后的生存率显著更高（分别为59%和38%）。这些结果表明，接受RM或MRM治疗的患者总体生存率相似。然而，有一部分癌症进展较严重的患者，其最终生存率可因RM而受到有利影响。
