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. 1987 Dec;23(12):1925-34. doi: 10.1016/0277-5379(87)90061-7.
This study compares the pattern of metastases in 228 patients with initial stage I and 635 patients with initial stage II breast cancer. All these patients had recurrence within a median time of follow-up of 4.9 years (range 2.0-7.0 years). All patients were initially mastectomized, and staging was based on histopathological evaluation of mastectomy specimens. Patients with stage II disease received postoperative radiotherapy; 67% also received systemic adjuvant therapy. Locoregional recurrences were the most common sites of recurrence in stage I, whereas distant metastases occurred more often in stage II patients. Stage II patients had a significantly higher number of metastatic sites than stage I patients. Among patients with a single site of recurrence the frequency of local or regional recurrence was 62% in stage I patients compared to 16% in stage II patients. When correcting for this difference, which was ascribed to the effect of radiotherapy, the number and the distribution of metastatic sites were almost equal in stage I and II patients. The anatomical distribution of metastatic sites in different periods after mastectomy was almost the same in stage I and stage II patients; extraregional lymph node metastases, however, occurred earlier in stage II than in stage I patients. The recurrence-free interval, the survival after recurrence (SAR), and the overall survival were all significantly shorter for stage II than for stage I patients. The reduced SAR for patients with stage II disease hints that tumours of higher stages have a higher rate of progression. The progression time, however, was of the same duration in patients with initial stage I and II breast cancer. The prognostic significance of the classification of patients with breast cancer according to stage does not seem to discriminate tumours with different biological properties with regard to the rate as well as the pattern of dissemination. Postmastectomy follow-up of patients with stage I and II disease should therefore, follow the same guide-lines. Since the anatomical distribution of metastases was the same in different periods after mastectomy, the screening for recurrent disease should not be directed towards any specific sites in certain periods after initial diagnosis.
本研究比较了228例初始为I期和635例初始为II期乳腺癌患者的转移模式。所有这些患者在中位随访时间4.9年（范围2.0 - 7.0年）内出现复发。所有患者最初均接受了乳房切除术，分期基于乳房切除标本的组织病理学评估。II期疾病患者接受了术后放疗；67%的患者还接受了全身辅助治疗。局部区域复发是I期最常见的复发部位，而远处转移在II期患者中更常见。II期患者的转移部位数量明显多于I期患者。在单部位复发的患者中，I期患者局部或区域复发的频率为62%，而II期患者为16%。校正这种归因于放疗影响的差异后，I期和II期患者转移部位的数量和分布几乎相等。I期和II期患者乳房切除术后不同时期转移部位的解剖分布几乎相同；然而，II期患者区域外淋巴结转移比I期患者出现得更早。II期患者的无复发生存期、复发后生存率（SAR）和总生存率均明显短于I期患者。II期疾病患者SAR降低表明更高分期的肿瘤进展速度更高。然而，初始I期和II期乳腺癌患者的进展时间持续相同。根据分期对乳腺癌患者进行分类的预后意义似乎并未在转移率和模式方面区分具有不同生物学特性的肿瘤。因此，I期和II期疾病患者乳房切除术后的随访应遵循相同的指导原则。由于乳房切除术后不同时期转移的解剖分布相同，因此复发疾病的筛查不应针对初始诊断后特定时期的任何特定部位。
