Kamby C, Rose C, Ejlertsen B, Andersen J, Birkler N E, Rytter L, Andersen K W, Zedeler K
Department of Oncology ONA, Finsen Institute, Rigshospitalet, Copenhagen, Denmark.
Eur J Cancer Clin Oncol. 1988 Mar;24(3):439-47. doi: 10.1016/s0277-5379(98)90014-1.
The aim was to analyze the impact of adjuvant systemic treatment (AST) on the anatomical distribution, the number, and the temporal relationship of the first metastases in 635 patients (pts) with breast cancer. These patients participated in the prospective studies of AST of the Danish Breast Cancer Cooperative Group (DBCG) 77-program. All patients had primary high-risk breast cancer (i.e. node positive or local invasion or tumor size greater than 5 cm). The initial treatment was mastectomy with axillary sampling, followed by postoperative radiotherapy. The types of AST and the number of patients with recurrence were: chemotherapy (CT), 134 pts; levamisole (LEV), 96 pts; tamoxifen (TAM), 154 pts. The pattern of recurrence in these patients was compared with the pattern of recurrence in 251 pts who did not receive AST (controls). Although CT reduced the total number of metastatic sites (P = 0.04), the incidence of liver metastases was increased compared to untreated controls (P = 0.02). The median number of metastatic sites was equal in TAM- and LEV-treated pts compared to controls. The incidence of lung metastases was increased in TAM-treated pts (P = 0.03), and LEV-treated pts had a decreased incidence of lymph node (P = 0.01) and pleural recurrences (P = 0.01) compared to controls. The results may suggest that mechanisms of clonal selection during the metastatic process involve differences in sensitivity to antineoplastic treatments of metastases at various anatomical locations.
目的是分析辅助全身治疗（AST）对635例乳腺癌患者首次转移的解剖分布、数量及时间关系的影响。这些患者参与了丹麦乳腺癌协作组（DBCG）77项目的AST前瞻性研究。所有患者均患有原发性高危乳腺癌（即淋巴结阳性、局部侵犯或肿瘤大小大于5 cm）。初始治疗为乳房切除术加腋窝取样，随后进行术后放疗。AST的类型及复发患者数量为：化疗（CT），134例；左旋咪唑（LEV），96例；他莫昔芬（TAM），154例。将这些患者的复发模式与251例未接受AST的患者（对照组）的复发模式进行比较。尽管CT减少了转移部位的总数（P = 0.04），但与未治疗的对照组相比，肝转移的发生率增加了（P = 0.02）。与对照组相比，接受TAM和LEV治疗的患者转移部位的中位数相同。接受TAM治疗的患者肺转移的发生率增加（P = 0.03），与对照组相比，接受LEV治疗的患者淋巴结复发（P = 0.01）和胸膜复发的发生率降低（P = 0.01）。结果可能提示，转移过程中的克隆选择机制涉及不同解剖部位转移灶对抗肿瘤治疗敏感性的差异。
