Kryj M, Maciejewski B, Withers H R, Taylor J M
Department of Surgery, Cancer Center, MSC Institute, Gliwice, Poland.
Neoplasma. 1997;44(1):3-11.
The purpose of this paper is to evaluate the incidence and kinetics of distant metastases in operable breast cancer and to relate these estimates to various tumor and patient characteristics. The records of 309 consecutive patients with operable breast cancer in stage T1-4N0-1M0 were reviewed, and the incidence of distant metastases (DM) and death due to DM were evaluated. 195 patients had positive axillary nodes with the following distribution of the number of nodes: 45% had 1-2 node, 16% had 3-4 nodes, 14% and 25% had 5-7 and more nodes, respectively. All patients were treated with radical mastectomy with axillary nodes dissection (the only treatment in 39% of cases). In 198 cases radical mastectomy was combined with radiotherapy and/or chemotherapy given pre- or postoperatively. Hormonal treatment was given in 27% of cases. Minimum follow-up was 10 years. Distant metastases were found in 150 cases (49%) and in 78 cases (25%) they developed early, during the first 18 months follow-up. Average rate of DM in N0 cases was 25%. Number of involved nodes and extracapsular invasion were found significant and independent prognostic factors. High risk (50%) of DM and death due to DM correlate with age < 40 y, premenopausal status, tumor stage > or = T3, more than 2 axillary nodes and/or extracapsular invasion. The linearity of the curves for freedom from DM and for freedom from death due to the DM suggest uniform distribution of progression rates with a median value for halving time for freedom from early DM of about 8 months, and of about 40 months for freedom from the DM occurring later than 18 months, being for whole group an average of 20 months. High incidence of DM is a significant cause of poor long-term survival. Early appearance (< 18 month follow-up) of about half of the DM suggests that they are already present as subclinical micrometastases at the time of initial loco-regional treatment. The time of appearance of distant metastases is consistent with a wide range of metastatic cell burdens among patients. Systemic therapy, at least for selected group of patients, might decrease the incidence of DM and improve long-term results.
本文旨在评估可手术乳腺癌远处转移的发生率和动力学，并将这些评估结果与各种肿瘤和患者特征相关联。回顾了309例连续的T1-4N0-1M0期可手术乳腺癌患者的记录，评估远处转移（DM）的发生率以及因DM导致的死亡情况。195例患者腋窝淋巴结阳性，淋巴结数量分布如下：45%有1-2枚淋巴结，16%有3-4枚淋巴结，14%和25%分别有5-7枚及更多淋巴结。所有患者均接受根治性乳房切除术及腋窝淋巴结清扫术（39%的病例为唯一治疗方式）。198例患者的根治性乳房切除术联合了术前或术后放疗和/或化疗。27%的病例接受了激素治疗。最短随访时间为10年。150例（49%）发现有远处转移，其中78例（25%）在随访的前18个月内早期发生远处转移。N0病例中DM的平均发生率为25%。发现受累淋巴结数量和包膜外侵犯是显著且独立的预后因素。DM及因DM导致死亡的高风险（50%）与年龄<40岁、绝经前状态、肿瘤分期≥T3、腋窝淋巴结超过2枚和/或包膜外侵犯相关。无DM生存曲线和无DM导致死亡生存曲线的线性表明进展率呈均匀分布，早期DM无进展时间减半的中位数约为8个月，18个月后发生的DM无进展时间减半的中位数约为40个月，全组平均为20个月。DM的高发生率是长期生存不佳的重要原因。约一半的DM早期出现（随访<18个月）表明在初始局部区域治疗时它们已作为亚临床微转移存在。远处转移出现的时间与患者中广泛的转移细胞负荷一致。全身治疗，至少对于特定患者群体，可能会降低DM的发生率并改善长期结果。
