Schain W S, d'Angelo T M, Dunn M E, Lichter A S, Pierce L J
Clinical Center, National Institutes of Health, Bethesda, MD.
Cancer. 1994 Feb 15;73(4):1221-8. doi: 10.1002/1097-0142(19940215)73:4<1221::aid-cncr2820730416>3.0.co;2-s.
Clinical trials comparing mastectomy to conservative surgery plus radiation therapy in the treatment of breast cancer have provided an opportunity to increase understanding of the biology of this disease and the psychological adaptation of the breast cancer patient. Because these local treatments appear to be equal in terms of survival, the question remains as to whether conservative surgery plus radiation therapy confers a measure of psychological comfort superior to that of mastectomy for women diagnosed with early-stage breast cancer.
One hundred forty-two women participating in a clinical trial randomizing patients to mastectomy or lumpectomy and radiation therapy were prospectively evaluated for psychological response to their respective local therapy. A baseline assessment before randomization and subsequent questionnaires at 6, 12, and 24 months after treatment were completed by patients entered in the clinical trial.
At 6 months, mastectomy patients reported significantly less control over events in their lives (P = 0.003) and more problems with sexual relations (P = 0.021) than did their conservatively treated counterparts. In addition, there were marked differences between mastectomy patients and lumpectomy and radiation therapy patients in the degree of distress over their nude bodies, with P = 0.001 at 6 months, P = 0.019 at 12 months, and P = 0.057 at 24 months.
From our findings, it appears that breast conservation therapy protects women's perception of their body but does not, over time, contribute to a more positive sexual adjustment.
比较乳房切除术与保乳手术加放射治疗在乳腺癌治疗中的临床试验，为增进对该疾病生物学特性及乳腺癌患者心理适应情况的了解提供了契机。由于这些局部治疗在生存率方面似乎相当，对于早期乳腺癌女性患者而言，保乳手术加放射治疗是否能带来比乳房切除术更高程度的心理安慰，仍是个问题。
142名参与临床试验的女性被随机分为接受乳房切除术或保乳手术加放射治疗两组，对她们各自接受局部治疗后的心理反应进行前瞻性评估。参与临床试验的患者在随机分组前完成基线评估，并在治疗后的6个月、12个月和24个月填写后续问卷。
在6个月时，乳房切除术患者报告称，与接受保乳治疗的患者相比，她们对生活中事件的掌控感明显更低（P = 0.003），并且在性关系方面存在更多问题（P = 0.021）。此外，乳房切除术患者与保乳手术加放射治疗患者在对自己裸体的苦恼程度上存在显著差异，6个月时P = 0.001，12个月时P = 0.019，24个月时P = 0.057。
根据我们的研究结果，保乳治疗似乎能保护女性对自己身体的认知，但随着时间推移，对更积极的性适应并无帮助。
