Hayward J L
Can J Surg. 1981 May;24(3):288-9.
Various methods have been explored for treating early breast cancer with conservation of the breast. Although local recurrence increased, early trials indicated that in patients with clinical stage I disease (T1 or T2 NO or N1a), wide excision and radiotherapy of the breast and gland fields resulted in the same distant recurrence and survival rates as the radical operation. It was suggested that local control of the disease was not important in the ultimate prognosis, that minimal surgery incurred no penalty and that breast cancer would soon be treated by radiotherapy alone. Four recent developments affected this forecast. 1. Assays of hormone receptors in primary tumours give important information on prognosis in early cancer. 2. In clinical stage II disease (T1 or T2 N1b), limited surgery exacts a penalty in terms of distant recurrence and survival. 3. The number in involved axillary lymph nodes must be known to evaluate prognosis 4. Adjuvant chemo- or endocrine therapy is effective in patients with extensive involvement of axillary nodes. Currently, only modified radical mastectomy effectively fulfils the requirements resulting from these developments.
人们探索了多种保留乳房治疗早期乳腺癌的方法。尽管局部复发率有所上升，但早期试验表明，对于临床I期疾病（T1或T2 NO或N1a）患者，乳房及腺体区域的广泛切除加放疗与根治性手术的远处复发率和生存率相同。有人提出，疾病的局部控制对最终预后并不重要，微创外科手术并无不利影响，而且乳腺癌很快将仅通过放疗进行治疗。最近的四项进展影响了这一预测。1. 原发肿瘤激素受体检测可为早期癌症的预后提供重要信息。2. 在临床II期疾病（T1或T2 N1b）中，有限手术在远处复发和生存方面会产生不利影响。3. 必须知道腋窝淋巴结受累数目才能评估预后。4. 辅助化疗或内分泌治疗对腋窝淋巴结广泛受累的患者有效。目前，只有改良根治性乳房切除术能有效满足这些进展带来的要求。
