Langlands A O
Division of Radiation Oncology, Westmead Hospital, New South Wales, Australia.
Aust N Z J Surg. 1995 Sep;65(9):630-3. doi: 10.1111/j.1445-2197.1995.tb00668.x.
Over the years three different concepts regarding the cure of treated breast cancer have emerged. These are clinical cure, personal cure and statistical cure. The latter is the most accurate estimate of the curability of a disease which is presumed to be fatal unless treated. Statistical cure is the elimination of the hazard of death in a treated group compared with an age-matched control population. When statistical cure is studied in patients treated for early breast cancer, it is clear that breast cancer is an incurable disease. The expected gains from the relatively recent introduction of adjuvant therapy are too small to alter this concept. The significance of prognostic factors in a disease deemed to be incurable therefore requires re-examination. The conventional prognostic factors of tumour size, nodal status and a combination of those two in staging systems significantly discriminates in terms of survival in the short term. However, when the characteristics of long-term survivors are examined, neither tumour size nor nodal status discriminates effectively. If this is the case, then we need to reconsider novel treatment strategies which have been introduced in the hope of increasing the curability of the disease and the selection for those treatment strategies of patients using the conventional prognostic factors of tumour size or nodal involvement.
多年来，出现了三种关于治愈乳腺癌的不同概念。它们分别是临床治愈、个体治愈和统计学治愈。后者是对一种疾病治愈率的最准确估计，这种疾病如果不治疗，被认为是致命的。统计学治愈是指与年龄匹配的对照人群相比，治疗组中死亡风险的消除。当对早期乳腺癌患者进行统计学治愈研究时，很明显乳腺癌是一种无法治愈的疾病。相对近期引入的辅助治疗所带来的预期收益太小，无法改变这一概念。因此，在一种被认为无法治愈的疾病中，预后因素的重要性需要重新审视。肿瘤大小、淋巴结状态以及分期系统中这两者的组合等传统预后因素在短期内对生存有显著的区分作用。然而，当研究长期幸存者的特征时，肿瘤大小和淋巴结状态都不能有效地进行区分。如果是这种情况，那么我们需要重新考虑为提高疾病治愈率而引入的新治疗策略，以及使用肿瘤大小或淋巴结受累等传统预后因素为患者选择这些治疗策略的问题。
