Yamamoto H
Dept. of Surgical Oncology, National Cancer Center Hospital, Tokyo, Japan.
Gan To Kagaku Ryoho. 1994 Dec;21(16):2720-7.
We analysed the results of relapse free survivals for breast cancer patients treated with traditional mastectomy through 10 years of follow up. In the consecutive series of 162 patients with Stage III breast tumor, we noted that the mastectomy followed by radiation to axilla and adjacent area failed to confirm the efficacy to support the prevention for local and distant relapse in the past decade (1962-1974) (27.2%). The concepts of neoadjuvant and/or adjuvant chemotherapy were evolved primarily from clinical trials: these have been shown to influence favorably for the 228 patients with STAGE III in the next decade (1975-1985) (46.1%). Modified mastectomy, which involved removal of the breast, overlying skin and axillary contents but spares the pectoralis muscle, has recently been established as an entirely satisfactory approach for STAGE I (295 patients) and STAGE II (281 patients) breast carcinomas (1986-1991). Five-year relapse free survivals of these 2 categories calculated 93.7% and 86.8%, respectively. In recent studies, the many trials to breast conservation therapy reported, such as partial mastectomy plus nodes dissection with or without radiotherapy for selected patients with early cancer represent as effective results as modified mastectomy. Breast preservation has focused attention on the extent and distribution of cancer (multifocality, residual foci of surgical margin, etc) for clinicians.
我们分析了接受传统乳房切除术的乳腺癌患者10年随访的无复发生存结果。在连续的162例III期乳腺肿瘤患者系列中，我们注意到在过去十年（1962 - 1974年）中，乳房切除术后对腋窝及邻近区域进行放疗未能证实其对预防局部和远处复发的有效性（27.2%）。新辅助和/或辅助化疗的概念主要源于临床试验：在接下来的十年（1975 - 1985年）中，这些方法已被证明对228例III期患者有良好影响（46.1%）。改良乳房切除术，即切除乳房、覆盖皮肤和腋窝内容物，但保留胸肌，最近已被确立为I期（295例患者）和II期（281例患者）乳腺癌（1986 - 1991年）完全令人满意的治疗方法。这两类患者的五年无复发生存率分别为93.7%和86.8%。在最近的研究中，许多关于保乳治疗的试验报告称，例如对选定的早期癌症患者进行部分乳房切除术加淋巴结清扫术（无论是否进行放疗），其效果与改良乳房切除术相同。保乳治疗使临床医生关注癌症的范围和分布（多灶性、手术切缘残留病灶等）。
