5-YEAR RESULTS OF A RANDOMIZED CLINICAL-TRIAL COMPARING TOTAL MASTECTOMY AND SEGMENTAL MASTECTOMY WITH OR WITHOUT RADIATION IN THE TREATMENT OF BREAST-CANCER
5-YEAR RESULTS OF A RANDOMIZED CLINICAL-TRIAL COMPARING TOTAL MASTECTOMY AND SEGMENTAL MASTECTOMY WITH OR WITHOUT RADIATION IN THE TREATMENT OF BREAST-CANCER
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DOI：
10.1056/nejm198503143121101
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发表时间：
1985-01-01
影响因子：
158.5
通讯作者：
RUSSELL, I
中科院分区：
文献类型：
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作者：
FISHER, B;BAUER, M;RUSSELL, I
一项评价I期和II期乳腺肿瘤治疗中通过节段性乳房切除术进行乳房保护的随机试验1976年开始制作4厘米的尺寸。手术仅切除足够的组织，以确保切除标本的边缘没有肿瘤。妇女被随机分配到全乳房切除术，部分乳房切除术单独或部分乳房切除术后乳房照射。所有患者均行腋窝淋巴结清扫术，淋巴结阳性的患者接受化疗。根据1843名妇女的数据进行的寿命表估计表明，采用节段性乳房切除术治疗，伴或不伴乳房照射，5年时无疾病、无远距离疾病和总生存率并不比全乳房切除术差。部分乳房切除术加放疗后的无病生存率优于全乳房切除术后的无病生存率（P = 0.04），部分乳房切除术后的总生存率（有或无放疗）优于全乳房切除术后的总生存率（分别为P = 0.07和0.06）。放疗组5年内无瘤率为92.3%，而未放疗组为72.1%（P < 0.001）。在淋巴结阳性的患者中，97.9%接受放射治疗的女性和63.8%未接受放射治疗的女性仍然无肿瘤（P < 0.001），尽管两组都接受了化疗。节段性乳房切除术，乳腺照射的所有患者和辅助化疗的妇女与积极的节点，是适当的治疗阶段I和II乳腺肿瘤。4 cm，前提是切除标本的边缘无肿瘤。
A randomized trial to evaluate breast conservation by a segmental mastectomy in the treatment of stage I and II breast tumors .ltoreq. 4 cm in size was begun in 1976. The operation removed only sufficient tissue to ensure that margins of resected specimens are free of tumor. Women were randomly assigned to total mastectomy, segmental mastectomy alone or segmental mastectomy followed by breast irradiation. All patients had axillary dissections, and patients with positive nodes received chemotherapy. Life-table estimates based on data from 1843 women indicated that treatment by segmental mastectomy, with or without breast irradiation, resulted in disease-free, distant-disease-free and overall survival at 5 yr that was no worse than that after total breast removal. Disease-free survival after segmental mastectomy plus radiation was better than disease-free survival after total mastectomy (P = 0.04), and overall survival after segmental mastectomy, with or without radiation, was better than overall survival after total mastectomy (P = 0.07, and 0.06, respectively). A total of 92.3% of women treated with radiation remained free of breast tumor at 5 yr, as compared with 72.1% of those receiving no radiation (P < 0.001). Among patients with positive nodes 97.9% of women treated with radiation and 63.8% of those receiving no radiation remained tumor-free (P < 0.001), although both groups received chemotherapy. Segmental mastectomy, followed by breast irradiation in all patients and adjuvant chemotherapy in women with positive nodes, is appropriate therapy for stage I and II breast tumors .mchlt. 4 cm, provided that margins of resected specimens are free of tumor.