Cady B, Stone M D, Schuler J G, Thakur R, Wanner M A, Lavin P T
Division of Surgical Oncology, New England Deaconess Hospital, Boston, Massachusetts, USA.
Arch Surg. 1996 Mar;131(3):301-8. doi: 10.1001/archsurg.1996.01430150079015.
To describe the magnitude of changes and opportunities that may arise for simplified surgical procedures for women with breast cancer because of the decreasing size and lymph node involvement in invasive breast cancer and earlier presentation of noninvasive and invasive breast cancer. DESIGN AND MAIN OUTCOME ASSESSMENT: Cases (N=1001) of breast cancer from a tertiary and a community hospital between 1989 and 1993 were analyzed for invasion, size, nodal status, and change over time.
Ductal carcinoma in situ constituted 14% and 18% of the cancers at the two hospitals. At the tertiary and community hospitals, the mean maximum diameters were 2.1 and 2.0 cm, respectively, and the median maximum diameters were 1.5 and 1.7 cm, respectively, for invasive breast cancer. Twenty-nine percent and 28%, respectively, were 1 cm or less in diameter. Axillary nodal metastases occurred in only 31% of the invasive cancers (tertiary hospital); only 10% had more than three nodal metastases. In the T1a and T1b cases, nodal metastases occurred in only 10% and 43% of the positive nodes were solitary; only 16% had more than three nodal metastases. The proportion of ductal carcinoma in situ, T1a and T1b, and node-negative cases increased significantly over time.
Within the next decade, the proportion of all breast cancers that are ductal carcinoma in situ will approach 33%, and invasive cancers will approach 1 cm in median maximum diameter. Therapy simplification will be logical because of very small size, low risk of recurrence after breast conservation, and excellent prognosis, and might include increased breast conservation, avoidance of axillary nodal dissection, and omission of radiation therapy to conserve breasts. Adjuvant therapy will be based on the prognostic features of the primary cancer and findings from careful histologic examination of the sentinel lymph nodes.
描述由于浸润性乳腺癌的大小减小、淋巴结受累情况减少以及非浸润性和浸润性乳腺癌的更早发现，可能给乳腺癌女性带来的简化手术程序的变化程度和机会。
分析了1989年至1993年间来自一家三级医院和一家社区医院的1001例乳腺癌病例的浸润情况、大小、淋巴结状态及随时间的变化。
两家医院原位导管癌分别占癌症的14%和18%。在三级医院和社区医院，浸润性乳腺癌的平均最大直径分别为2.1厘米和2.0厘米，中位最大直径分别为1.5厘米和1.7厘米。直径1厘米及以下的分别占29%和28%。仅31%的浸润性癌症（三级医院）发生腋窝淋巴结转移；只有10%有超过三个淋巴结转移。在T1a和T1b病例中，仅10%发生淋巴结转移，且43%的阳性淋巴结为孤立性；只有16%有超过三个淋巴结转移。原位导管癌、T1a和T1b以及淋巴结阴性病例的比例随时间显著增加。
在未来十年内，原位导管癌在所有乳腺癌中的比例将接近33%，浸润性癌症的中位最大直径将接近1厘米。由于肿瘤非常小、保乳后复发风险低且预后良好，简化治疗将是合理的，可能包括增加保乳、避免腋窝淋巴结清扫以及省略放疗以保留乳房。辅助治疗将基于原发癌的预后特征以及前哨淋巴结仔细组织学检查的结果。
