The process of metastasisation for breast cancer
The process of metastasisation for breast cancer
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DOI：
10.1016/s0959-8049(03)00422-2
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发表时间：
2003-08-01
影响因子：
8.4
通讯作者：
Hölzel, D
中科院分区：
文献类型：
--
作者：
Engel, J;Eckel, R;Hölzel, D
为了研究转移的过程，分析了1978年至1996年慕尼黑癌症登记处的主要临床数据和疾病事件，如转移、局部复发和生存（中位随访9.4年）。由于转移，即使是来自小肿瘤，也可能在原发性肿瘤诊断之前开始，因此原发性肿瘤的生长和转移可能是两个自主过程。在我们的数据中，转移后的生存率与原发肿瘤的大小几乎无关。然而，M1病例的数量和转移时间取决于诊断时的肿瘤直径。从开始转移到诊断的时间估计为5.8年。转移瘤的生长几乎是均匀的。然而，转移后的生长时间取决于无肿瘤时间、受体状态和组织学分级，仅变化约2倍。局部复发，首先，是转移的指标。此外，局部复发也可能具有转移的可能性。估计诊断后9.3年内局部复发导致的额外死亡率。我们假设的转移模型说明了早期发现的重要性，保乳治疗的概念和局部复发的额外转移。它突出了原发性肿瘤的最佳局部治疗的益处和全身治疗的局限性。它还质疑腋窝清扫和淋巴结照射的使用。将其推广到实体瘤可能有助于澄清目前许多有争议的争论。(C)2003 Elsevier Ltd.保留所有权利。
To investigate the process of metastasis, primary clinical data and disease events such as metastases, local recurrence and survival (median follow-up 9.4 years) from the Munich Cancer Registry from 1978 to 1996 were analysed. Since metastases, even from small tumours, may be initiated before the diagnosis of the primary tumour, the growth of the primary tumour and metastasisation may be two autonomous processes. In our data, survival following metastases was almost unrelated to primary tumour size. However, the number of M1 cases and the time to metastasisation depended on the tumour diameter at diagnosis. The time from initiation of metastases to its diagnosis was estimated as 5.8 years. The growth of metastases was almost homogeneous. However, the growth time following metastasisation-depending on the metastases-free time, receptor status and histological grade-only varied by approximately a factor of 2. Local recurrence, above all, was an indicator of metastases. Furthermore, local recurrence may also have the potential to metastasise. Excess mortality due to local recurrence was estimated up to 9.3 years after diagnosis. Our hypothesised metastases model illustrates the importance of early detection, the concept of breast-conserving therapy and additional metastases from local recurrence. It highlights the benefits of optimal local therapy of the primary tumour and the limitations of systemic therapy. It also questions the use of axilla dissection and lymph node irradiation. Its generalisation to solid tumours may help to clarify many of the current controversial debates. (C) 2003 Elsevier Ltd. All rights reserved.