Veronesi U, Salvadori B, Luini A, Greco M, Saccozzi R, del Vecchio M, Mariani L, Zurrida S, Rilke F
Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy.
Eur J Cancer. 1995 Sep;31A(10):1574-9. doi: 10.1016/0959-8049(95)00271-j.
Breast conservation has become well-established in the treatment of early mammary carcinoma. However, a standardised treatment modality has not emerged. We have analysed the data from 1,973 patients treated in three consecutive randomised trials by four different radiosurgical procedures: Halsted mastectomy, quadrantectomy plus radiotherapy, lumpectomy plus radiotherapy, and quadrantectomy without radiotherapy, to compare the outcomes of these procedures in terms of local recurrence rate and overall survival. Eligibility criteria were similar in the three trials, and comparability between the four subgroups was excellent. Median follow-up for all patients was 82 months. The annual rates of local recurrence varied markedly according to the treatment. Patients treated with Halsted mastectomy and quadrantectomy plus radiotherapy had low annual rates of local recurrence (0.20 and 0.46, respectively) while both lumpectomy plus radiotherapy and quadrantectomy without radiotherapy had significantly higher rates (2.45 and 3.28, respectively). Patients under 45 years of age had a much higher incidence of local recurrences, while in women over 55 years local recurrences were much less frequent. Overall survival curves were identical in the four groups of patients, so that the three breast conserving radiosurgical procedures had the same survival rates as Halsted mastectomy. However, local recurrence rates were markedly influenced by the treatment method, patient age and specific histological features.
保乳手术在早期乳腺癌治疗中已得到广泛应用。然而，尚未出现标准化的治疗模式。我们分析了连续三项随机试验中1973例患者的数据，这些患者接受了四种不同的放射外科手术：Halsted乳房切除术、象限切除术加放疗、肿块切除术加放疗以及未行放疗的象限切除术，以比较这些手术在局部复发率和总生存率方面的结果。三项试验的入选标准相似，四个亚组之间的可比性极佳。所有患者的中位随访时间为82个月。局部复发的年发生率因治疗方法而异。接受Halsted乳房切除术和象限切除术加放疗的患者局部复发年发生率较低（分别为0.20和0.46），而肿块切除术加放疗和未行放疗的象限切除术的发生率则显著较高（分别为2.45和3.28）。45岁以下患者的局部复发发生率要高得多，而55岁以上女性的局部复发则少得多。四组患者的总生存曲线相同，因此三种保乳放射外科手术的生存率与Halsted乳房切除术相同。然而，局部复发率受治疗方法、患者年龄和特定组织学特征的显著影响。
