Langlands A O, Pocock S J, Kerr G R, Gore S M
Br Med J. 1979 Nov 17;2(6200):1247-51. doi: 10.1136/bmj.2.6200.1247.
A retrospective analysis was made of 3878 cases of breast carcinoma first seen in Edinburgh from 1954 to 1964. During this time there was a policy to treat breast cancer by simple mastectomy and x-ray therapy, and over 90% of cases classified as international stages I and II were so treated. The mortality in these women was compared with that in an equivalent normal population using Scottish national age-specific death rates. For every year of follow-up within 20 years of initial treatment there was an excess mortality from all causes. There was an overall excess mortality of 58% among patients with breast cancer 15-20 years after initial treatment, and 20 times more deaths occurred in this period from breast cancer than in a normal population. For patients disease-free after 15 years there was still a 28% excess mortality from all causes. Factors known to be of major prognostic significance for five-year survivorship had less influence than might have been expected when the ratio of observed to expected deaths was considered for longer periods of follow-up. The effect of clinical staging (I, II, or III), though initially marked, largely disappeared by the 10th year of follow-up, and after allowing for age there was no evidence beyond 10 years of an effect on survival of the original stage of the disease. Similarly, the effect of tumour size on survival disappeared after 10 years. Women who were premenopausal at presentation still had a significant excess of deaths in the fourth quinquennium of follow-up. In the menopausal and postmenopausal groups combined there was still a small non-significant excess of deaths from all causes after 15 years but this almost disappeared when patients who had already relapsed were excluded. In terms of overall mortality only patients who have undergone the menopause before presentation and who are disease-free 15 years after primary treatment may prove to be cured by conventional techniques such as simple mastectomy and postoperative radiotherapy.
对1954年至1964年在爱丁堡初诊的3878例乳腺癌病例进行了回顾性分析。在此期间，采用单纯乳房切除术和X线治疗乳腺癌的政策，90%以上分类为国际I期和II期的病例接受了这种治疗。使用苏格兰全国特定年龄死亡率，将这些女性的死亡率与同等正常人群的死亡率进行了比较。在初始治疗后的20年内，每随访一年，各种原因导致的死亡率均有超额。初始治疗15 - 20年后，乳腺癌患者的总超额死亡率为58%，在此期间因乳腺癌死亡的人数是正常人群的20倍。对于15年后无病的患者，各种原因导致的超额死亡率仍为28%。已知对五年生存率具有主要预后意义的因素，在考虑更长随访期的观察死亡与预期死亡比率时，其影响小于预期。临床分期（I、II或III期）的影响虽然最初明显，但在随访第10年时基本消失，在考虑年龄因素后，10年后没有证据表明疾病的初始分期对生存有影响。同样，肿瘤大小对生存的影响在10年后消失。就诊时处于绝经前的女性在随访的第四个五年期内死亡人数仍显著超额。绝经组和绝经后组合并后，15年后各种原因导致的死亡仍有少量不显著的超额，但排除已复发的患者后，这种超额几乎消失。就总体死亡率而言，只有就诊前已绝经且在初次治疗15年后无病的患者，可能通过单纯乳房切除术和术后放疗等传统技术治愈。
