Veronesi U, Valagussa P
Cancer. 1981 Jan 1;47(1):170-5. doi: 10.1002/1097-0142(19810101)47:1<170::aid-cncr2820470128>3.0.co;2-c.
From January 1964 to January 1968, 737 patients with breast cancer were randomized at the Cancer Institute in Milan to undergo either Halsted mastectomy or Halsted mastectomy with internal mammary node dissection; 716 were considered evaluable. The series was part of an international cooperative study. The two groups of patients were comparable in age, menopausal status, quadrant distribution, and frequency of axillary metastases. No patients received postoperative radiotherapy or adjuvant treatments. At ten years, no difference was found in either in the length of disease-free or overall survival in the two series. The overall survival was 60.7% in patients treated with Halsted mastectomy and 57.0% in patients treated with Halsted mastectomy plus internal mammary dissection. In no subgroups was a statistically significant difference found. In the series treated by extended mastectomy, the incidence of internal mammary metastases was 20.5% (24.6% in cases with tumor in medial or central quadrants and 17.7% in cases with tumor in lateral quadrants). The follow-up of the patients treated by Halsted mastectomy showed that only 15 had a parasternal recurrence; the expected number was 75. In nine patients, parasternal recurrences were the first site of relapse of the disease. All of them were treated with radiotherapy, and in four a complete control was obtained.
1964年1月至1968年1月，米兰癌症研究所将737例乳腺癌患者随机分为两组，分别接受哈尔斯特德乳房切除术或哈尔斯特德乳房切除术加胸骨旁淋巴结清扫术；716例患者被认为可进行评估。该系列研究是一项国际合作研究的一部分。两组患者在年龄、绝经状态、象限分布和腋窝转移频率方面具有可比性。所有患者均未接受术后放疗或辅助治疗。十年后，两个系列的无病生存期或总生存期均未发现差异。接受哈尔斯特德乳房切除术的患者总生存率为60.7%，接受哈尔斯特德乳房切除术加胸骨旁淋巴结清扫术的患者总生存率为57.0%。在任何亚组中均未发现统计学上的显著差异。在接受扩大根治术的系列研究中，胸骨旁转移的发生率为20.5%（内侧或中央象限肿瘤患者为24.6%，外侧象限肿瘤患者为17.7%）。对接受哈尔斯特德乳房切除术的患者进行随访发现，只有15例发生了胸骨旁复发；预期复发例数为75例。在9例患者中，胸骨旁复发是疾病复发的首发部位。所有这些患者均接受了放疗，其中4例实现了完全控制。
