Sutherland C M, Mather F J
Cancer. 1986 Feb 1;57(3):622-9. doi: 10.1002/1097-0142(19860201)57:3<622::aid-cncr2820570338>3.0.co;2-c.
Uncertainty exists regarding the magnitude of excess mortality from localized breast cancer at long follow-up times (greater than 15 years) since diagnosis and regarding the effects of race and age as prognostic factors at all follow-up times. Long-term survival was determined in 1141 patients (311 white, 830 black) diagnosed as having localized breast cancer with and without positive axillary lymph nodes, but without any signs of complete or incomplete skin, muscle, or chest wall attachment. Survival curves were estimated by means of actuarial methods; prognostic factors were evaluated with the Cox's regression analysis. Survival from all causes was 62%, 43%, 33%, 25%, and 18% at 5, 10, 15, 20, and 30 years, respectively. Breast cancer-specific survival was 76%, 65%, 63%, 61%, and 59% at 5, 10, 15, 20, and 30 years, respectively. Breast cancer-specific hazard rates exceeded those expected in the general population by 119 times, 53 times, 12 times, and 6 times at 0 to 5, 5 to 10, 10 to 20, and 20 to 25 years, respectively. Of the 395 patients enrolled after 1968 who had modified radical or radical surgery, 338 had known number of positive nodes and size of tumor. Breast cancer-specific survival was significantly increased with: a decreasing number of positive lymph nodes, 0, 1 to 3, and 4 or more (P = 0.000); later year of diagnosis (1974 or before versus 1975 or later) (P = 0.000); and possibly, tumor size of 7.0 cm or less (P = 0.09). When these variables were controlled, no significant association of age at diagnosis or race with breast cancer-specific survival was found. These data suggest that the number of nodes, year of diagnosis and, possibly, tumor size are important prognostic factors for survival, but race and age are not. Also, excess mortality may exist at late intervals; however, it is small in relation to other causes.
自诊断以来，在长期随访时间（超过15年）时，局部乳腺癌的超额死亡率的幅度以及在所有随访时间种族和年龄作为预后因素的影响尚不确定。对1141例诊断为局部乳腺癌的患者（311例白人，830例黑人）进行了长期生存情况的测定，这些患者腋窝淋巴结有无转移，但均无皮肤、肌肉或胸壁完全或不完全附着的任何迹象。采用精算方法估计生存曲线；用Cox回归分析评估预后因素。全因生存率在5年、10年、15年、20年和30年时分别为62%、43%、33%、25%和18%。乳腺癌特异性生存率在5年、10年、15年、20年和30年时分别为76%、65%、63%、61%和59%。乳腺癌特异性风险率在0至5年、5至10年、10至20年和20至25年时分别超过一般人群预期值的119倍、53倍、12倍和6倍。在1968年后接受改良根治术或根治术的395例患者中，338例已知阳性淋巴结数量和肿瘤大小。乳腺癌特异性生存率随着以下因素显著提高：阳性淋巴结数量减少，分别为0个、1至3个和4个或更多（P = 0.000）；诊断年份较晚（1974年或之前与1975年或之后）（P = 0.000）；以及可能肿瘤大小为7.0 cm或更小（P = 0.09）。当控制这些变量时，未发现诊断时年龄或种族与乳腺癌特异性生存率之间存在显著关联。这些数据表明，淋巴结数量、诊断年份以及可能的肿瘤大小是生存的重要预后因素，但种族和年龄不是。此外，晚期可能存在超额死亡率；然而，与其他原因相比，其数值较小。
