Winchester D J, Menck H R, Winchester D P
Department of Surgery, Northwestern University Medical School, Chicago, Illinois, USA.
Cancer. 1997 Jul 1;80(1):162-7.
Although the conclusions reached in the National Surgical Adjuvant Bowel and Breast Protocol B-06 trial and other clinical trials appear to remain intact, questions persist regarding the equivalency of breast preservation compared with modified radical mastectomy for patients with invasive carcinoma. Documentation and assessment of comparative survival rates in a large cohort of nonrandomized breast carcinoma patients was undertaken to understand better these outcome patterns.
Information gathered from the medical records of 96,030 women diagnosed with early stage carcinoma of the breast between 1985 and 1988 was reviewed to determine the age at diagnosis; tumor stage, grade, dimension; treatment; and disease status.
Of these 96,030 Stage I and II (based on the American Joint Committee on Cancer staging system) patients, 8583 (8.9%) were treated with segmental mastectomy, axillary lymph node dissection, and radiotherapy without systemic treatment. Three thousand seven hundred and ninety-seven patients (4.0%) were treated with segmental mastectomy, axillary lymph node dissection, radiotherapy, and systemic therapy. Forty-four thousand two hundred and forty-nine patients (46.0%) were treated with modified radical mastectomy without systemic therapy, and 18,322 patients (19.1%) were treated with modified radical mastectomy with systemic therapy. Within each stage, reported survival was equal to or more favorable for patients managed with breast preservation compared with those treated with modified radical mastectomy. This comparability was observed in all subsets analyzed including those defined by age at diagnosis, histologic grade, and tumor dimension.
These findings are consistent with the hypothesis that AJCC Stage I and II patients treated with breast preservation appear to have survival rates equivalent to those treated with modified radical mastectomy.
尽管国家外科辅助乳腺和肠道项目B - 06试验及其他临床试验得出的结论似乎仍然有效，但对于浸润性癌患者，保乳术与改良根治性乳房切除术的等效性仍存在疑问。为了更好地理解这些结果模式，我们对一大群非随机乳腺癌患者的相对生存率进行了记录和评估。
回顾了从1985年至1988年期间诊断为早期乳腺癌的96030名女性的病历信息，以确定诊断时的年龄、肿瘤分期、分级、大小、治疗方式及疾病状态。
在这96030名I期和II期（基于美国癌症联合委员会分期系统）患者中，8583名（8.9%）接受了区段乳房切除术、腋窝淋巴结清扫术和放疗，未进行全身治疗。3797名患者（4.0%）接受了区段乳房切除术、腋窝淋巴结清扫术、放疗及全身治疗。44249名患者（46.0%）接受了改良根治性乳房切除术，未进行全身治疗，18322名患者（19.1%）接受了改良根治性乳房切除术并进行了全身治疗。在每个分期内，与接受改良根治性乳房切除术的患者相比，接受保乳治疗的患者报告的生存率相同或更高。在所有分析的亚组中均观察到这种可比性，包括根据诊断时年龄、组织学分级和肿瘤大小定义的亚组。
这些发现与以下假设一致，即接受保乳治疗的美国癌症联合委员会I期和II期患者的生存率似乎与接受改良根治性乳房切除术的患者相当。
