Casolo P, Mosca D, Amorotti C, Raspadori A, Drei B, Di Blasio P, Colli G, De Maria R, De Luca G, Ganz E, Amuso D
Dipartimento di Chirurgia, Università degli Studi di Modena.
Ann Ital Chir. 1997 Mar-Apr;68(2):195-204; discussion 204-5.
The authors report the results of a prospective study on 204 patients (1980-1993) affected by early infiltrating breast cancer (size pounds 2 cm) as a part of a surgical series of 608 cases. 53 cases who underwent QUART (25.9%) and 151 cases (74.1%) who underwent mastectomy modified according to Patey have been collected. 10 years actuarial survival has been respectively 79% after extensive surgery and 78% after conservative treatment. Local recurrences have been observed in 9 cases after meticulous follow-up (median 74.8 months, range 12-178): 3 (5.66%) patients after QUART and 6 (3.97%) after mastectomy; furthermore 1 patients after a conservative treatment (1.88%) has developed a second tumor at the same side probably dependent on the presence in the primary tumor of an extensive intraductal component. No correlations between histological features, grading, positive nodes, receptor status and local recurrences have been found. Only the age of patients looks significantly correlated with frequency of recurrences: 44.45% of local recurrences have been observed in patients less than 45 years old. Local recurrences after QUART have obliged, in all cases, to a radical mastectomy. Furthermore, frequency of distant metastases has been considered: after QUART percentage is lower (9.43%) than after radical mastectomy (13.9%). This consideration looks correlated with the longer follow-up of the later group. A multidisciplinary approach is advised but the most important role is played by surgery. In conclusion it is outlined that conservative surgery is addressed to selection and consenting patients.
作者报告了一项对204例早期浸润性乳腺癌（肿瘤大小≤2cm）患者（1980 - 1993年）进行的前瞻性研究结果，该研究是608例手术病例系列的一部分。收集了53例行象限切除术（25.9%）和151例行Patey改良乳房切除术（74.1%）的病例。广泛手术后10年精算生存率为79%，保守治疗后为78%。经过细致随访（中位随访74.8个月，范围12 - 178个月），观察到9例局部复发：象限切除术后3例（5.66%），乳房切除术后6例（3.97%）；此外，1例接受保守治疗的患者（1.88%）在同侧发生了第二个肿瘤，可能与原发肿瘤中广泛的导管内成分有关。未发现组织学特征、分级、淋巴结阳性、受体状态与局部复发之间存在相关性。仅患者年龄与复发频率显著相关：45岁以下患者中观察到44.45%的局部复发。象限切除术后的局部复发在所有病例中均需行根治性乳房切除术。此外，还考虑了远处转移的频率：象限切除术后的百分比（9.43%）低于根治性乳房切除术后（13.9%）。这种情况似乎与后一组更长的随访时间有关。建议采用多学科方法，但手术起着最重要的作用。总之，概述了保守手术适用于经过选择并同意的患者。
