Gamel J W, Meyer J S, Feuer E, Miller B A
Veterans Administration Medical Center, Louisville, Kentucky, USA.
Cancer. 1996 Apr 15;77(8):1459-64. doi: 10.1002/(SICI)1097-0142(19960415)77:8<1459::AID-CNCR6>3.0.CO;2-7.
Stage and histologic type have a significant impact on the long term clinical course of breast carcinoma. Clinical course is governed by two components: likelihood of cure and medial tumor-related survival time among uncured patients. Estimates of these components can be derived only by using survival models that incorporate cured fraction as a specific parameter.
The prognostic value of stage and histologic type was determined for 163,808 patients with breast carcinoma using the log normal and log logit cure-based survival models. Follow-up ranged from 1 month to 19 years and was obtained from the SEER Program.
In approximate terms, ductal carcinoma was diagnosed in 70% of the patients, with estimate cured fractions of 2/3 and 1/3 for local and regional disease, respectively. Estimates of medial survival times for uncured patients were 10 and 5 years. Findings were similar for patients with tumor of miscellaneous histologic types. For patients with medullary carcinoma were 82% and 50%, with median survival times of 6 and 4 years. For patients with mucinous, lobular, and ductolobular carcinomas, parametric analysis gave inconsistent estimates of cured fraction, but findings suggested unusually long tumor-related survival times.
Cured-based parametric survival models offer valuable insight into the impact of stage and histology on the clinical course of breast cancer.
分期和组织学类型对乳腺癌的长期临床病程有重大影响。临床病程由两个部分决定：治愈的可能性以及未治愈患者中与肿瘤相关的中位生存时间。只有使用将治愈比例作为特定参数纳入的生存模型，才能得出这些部分的估计值。
使用基于对数正态和对数对数治愈的生存模型，对163,808例乳腺癌患者的分期和组织学类型的预后价值进行了测定。随访时间从1个月到19年不等，数据来自监测、流行病学和最终结果（SEER）计划。
大致而言，70%的患者被诊断为导管癌，局部和区域疾病的估计治愈比例分别为2/3和1/3。未治愈患者的中位生存时间估计分别为10年和5年。组织学类型混杂的肿瘤患者也有类似的结果。髓样癌患者的估计治愈比例分别为82%和50%，中位生存时间分别为6年和4年。对于黏液癌、小叶癌和导管小叶癌患者，参数分析得出的治愈比例估计不一致，但结果表明与肿瘤相关的生存时间异常长。
基于治愈的参数生存模型为分期和组织学对乳腺癌临床病程的影响提供了有价值的见解。
