Levitt S H, Aeppli D M, Nierengarten M E
Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Health Center, Minneapolis, USA.
Cancer. 1996 Sep 1;78(5):1035-42. doi: 10.1002/(SICI)1097-0142(19960901)78:5<1035::AID-CNCR13>3.0.CO;2-3.
A Bayesian statistical approach was used to examine the effect of local control on survival of patients with early breast carcinoma.
The effect of radiation on overall survival was examined in the four published randomized trials on conservation surgery with or without radiation: the Uppsala-Orebro, Canadian, NSABP-B06, and Milan III trials. Classical and Bayesian statistical approaches were used to evaluate the effect of sample size and follow-up on the results.
Combined 5-year survival results of patients with negative lymph nodes and surgical margins in the Uppsala-Orebro, Canadian, and NSABP-B06 trials indicated a 79% probability of a positive benefit with the addition of radiation and a 9.6% relative reduction in the annual mortality rate in favor of the irradiated patients. For the same subgroup of patients in the NSABP-B06 trial, the probability of a positive benefit with radiation increased from 65% at 5 years to 87% at 10 years, and is reflected in the change of the relative reduction in annual mortality from 8.2% at 5 years to 17.5% at 10 years. For all patients who accepted randomized treatment in the NSABP-B06 trial, the probability of a positive survival benefit with radiation was 80%, 98%, and 91% at 5, 10, and 12 years, respectively, with corresponding relative reductions in the annual mortality rates of 12.8%, 20.5%, and 15.2%.
The addition of radiation to lumpectomy offers a small but important survival advantage, even in patients with negative surgical margins and lymph nodes. Because locoregional control and breast preservation are significantly improved with radiation, even a small survival advantage substantiates the importance of radiation in the treatment of patients with early breast carcinoma.
采用贝叶斯统计方法研究局部控制对早期乳腺癌患者生存的影响。
在四项已发表的关于保乳手术加或不加放疗的随机试验中，即乌普萨拉 - 厄勒布鲁试验、加拿大试验、NSABP - B06试验和米兰III试验，研究放疗对总生存的影响。使用经典和贝叶斯统计方法评估样本量和随访对结果的影响。
乌普萨拉 - 厄勒布鲁试验、加拿大试验和NSABP - B06试验中淋巴结及手术切缘阴性患者的5年联合生存结果表明，加用放疗有阳性获益的概率为79%，放疗组患者的年死亡率相对降低9.6%。对于NSABP - B06试验中同一亚组患者，放疗有阳性获益的概率从5年时的65%增至10年时的87%，这反映在年死亡率相对降低率从5年时的8.2%变为10年时的17.5%。对于NSABP - B06试验中所有接受随机治疗的患者，放疗有阳性生存获益的概率在5年、10年和12年时分别为80%、98%和91%，相应的年死亡率相对降低率分别为12.8%、20.5%和15.2%。
即使对于手术切缘和淋巴结阴性的患者，在肿块切除术中加用放疗也能带来虽小但重要的生存优势。由于放疗能显著改善局部区域控制和保乳效果，即使是微小的生存优势也证实了放疗在早期乳腺癌患者治疗中的重要性。
