Heuson J C
Acta Chir Belg. 1980 Mar-Apr;79(2):89-93.
The implications of medical adjuvant treatments of primary breast cancer are best appreciated from an analysis of the available data on rates of local recurrence and survival after mastectomy. Breast cancer may be considered as a systemic disease from the time of clinical presentation in most cases and its cure rate has been estimated at 18% for all cases and 30% for stages I and II combined. Advancing age seems attended by an increasing rate of dying from breast cancer. Local recurrences appear to obey the same mechanisms that govern the occurrence of distant metastases. Their appearance after mastectomy has an average or median delay of one to two years. These data are important factors that condition the indication and planning of reconstructive surgery. They form the background on which adjuvant treatments will exert their influence. Prophylactic castration is of little or no value in altering survival after mastectomy. In contrast, intensive long-term combination chemotherapy of the CMF type seems to increase the relapse-free survival and overall survival, and to decrease the rate of local recurrence specifically in premenopausal patients. It is little or not effective after the menopause. Intensive research is needed to develop better modalities of systemic adjuvant treatment in order to improve the curability of breast cancer.
对原发性乳腺癌进行医学辅助治疗的意义，最好通过分析乳房切除术后局部复发率和生存率的现有数据来理解。在大多数情况下，从临床表现时起，乳腺癌就可被视为一种全身性疾病，据估计，所有病例的治愈率为18%，I期和II期合并病例的治愈率为30%。随着年龄的增长，死于乳腺癌的比率似乎也在上升。局部复发似乎遵循与远处转移发生相同的机制。乳房切除术后局部复发出现的平均或中位延迟时间为一到两年。这些数据是决定重建手术指征和规划的重要因素。它们构成了辅助治疗发挥作用的背景。预防性去势在改变乳房切除术后的生存率方面几乎没有价值。相比之下，CMF类型的强化长期联合化疗似乎能提高无复发生存率和总生存率，并特别降低绝经前患者的局部复发率。绝经后效果甚微或无效。需要进行深入研究以开发更好的全身辅助治疗方式，从而提高乳腺癌的治愈率。
