Mondini G, Friedman D, De Cian F, Spirito C, Carrabetta S, Costantini M, Sormani M P, Civalleri D
Istituto di Clinica Chirurgia I, Università degli Studi di Genova.
G Chir. 1997 Jan-Feb;18(1-2):7-11.
The influence of timing of surgery in relation to menstrual period on survival of breast cancer patients has been both advanced advocated and disputed. A meta-analysis on published series showed a statistically significant overall odds reduction when surgery is performed in the luteal phase. The records of 165 premenopausal M- breast cancer women, not on hormonal therapies, consecutively operated on from 1977 to 1991 were reviewed. All patients underwent modified radical mastectomies or quadrantectomies plus operative radiotherapy, Node-positive patients received standard adjuvant chemotherapy. Cox regression analysis was used to estimate the relative risk (RR) of death in three models including timing of surgery, age, histology, pathological T and N. In each model, patients were divided into two groups according to the criteria proposed by Badwe, Hrushesky, and Senie. Multivariate analysis showed a significant association between pT and pN and survival, whereas no association with survival was observed for timing of surgery according to Badwe or Hrushesky or Senie criteria (RR = 1.26, RR = 0.91, and RR = 0.88 respectively). Up-to-date agreement on the menstrual phase and relative expected better prognosis is still lacking.
手术时间与月经周期的关系对乳腺癌患者生存率的影响一直存在不同观点,有人提倡,也有人提出质疑。一项对已发表系列研究的荟萃分析表明,在黄体期进行手术时,总体优势比在统计学上有显著降低。回顾了1977年至1991年期间连续接受手术的165例未接受激素治疗的绝经前M期乳腺癌女性的记录。所有患者均接受了改良根治性乳房切除术或象限切除术加手术放疗,淋巴结阳性患者接受了标准辅助化疗。使用Cox回归分析在包括手术时间、年龄、组织学、病理T和N的三个模型中估计死亡的相对风险(RR)。在每个模型中,根据Badwe、Hrushesky和Senie提出的标准将患者分为两组。多变量分析显示pT和pN与生存率之间存在显著关联,而根据Badwe、Hrushesky或Senie标准,手术时间与生存率无关联(RR分别为1.26、0.91和0.88)。目前对于月经周期以及相对更好预后仍缺乏一致意见。