Breast carcinoma: Pattern of recurrence and metastasis after mastectomy
Breast carcinoma: Pattern of recurrence and metastasis after mastectomy
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乳腺癌：乳房切除术后复发和转移的模式
DOI：
10.1097/00000421-198410000-00010
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发表时间：
1984
期刊：
影响因子：
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通讯作者：
Y. Lee
中科院分区：
文献类型：
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作者：
Y. Lee
本文对1971-1980年556例乳腺癌患者进行了回顾性分析。在476名接受乳房切除术的患者中，38%的患者死亡，存活患者的中位随访时间为53个月。当腋窝淋巴结最初没有转移时，18%的患者复发。有腋窝淋巴结转移的患者中，1-3个阳性淋巴结的复发率为24%，≥ 4个阳性淋巴结的复发率为69%。关于首次复发的具体类型，约10 - 30%有局部区域复发，60 - 70%有远处转移，10 - 30%两者兼有（累及≥ 4个淋巴结的患者仅局部区域复发的可能性较小）。术后放射治疗降低了孤立性局部区域复发的频率，但并没有降低总的失败率，也没有影响传播的机会。在有一个或多个腋窝淋巴结阳性的患者中，辅助化疗（美法仑或CMF）并没有显著降低复发率，也没有改变复发类型。因此，远处转移是乳房切除术后复发的主要问题。初始传播的相对分布与诊断时患有IV期疾病的80例患者相似。最常见的五个部位是骨（占远处转移的40 - 60%）、肺（15 - 22%）、胸膜（10 - 14%）、软组织（7 - 15%）和肝（5 - 15%）。
THIS IS A RETROSPECTIVE REVIEW OF 556 PATIENTS who had carcinoma of the breast (1971–1980). Among the 476 patients who had mastectomy, 38% have died and the median follow-up time of those who were alive was 53 months. When the axillary nodes were free of metastasis initially, 18% of the patients had relapse. Among the patients who had axillary nodal metastasis, 24% of those with 1–3 positive nodes, and 69% of those with ≥4 positive nodes relapsed. Regarding specific type of first recurrence, about 10–30% had loco-regional relapse, 60–70% had distant metastasis and 10–30% had both (patients with ≥4 lymph nodes involved are less likely to have only loco-regional relapse). Postoperative radiotherapy decreased the frequency of isolated loco-regional relapse, but did not decrease the overall failure rate nor influence the chance of dissemination. Among patients who had one or more positive axillary nodes, adjuvant chemotherapy (melphalan or CMF) did not significantly decrease relapse rates nor change types of relapse. Thus, distant dissemination is the major problem for those who developed recurrence after mastectomy. The relative distribution of the initial spread is similar to that seen among the 80 patients who had Stage IV disease at diagnosis. The most common five sites are bone (which accounted for 40–60% of the distant metastasis), lung (15–22%), pleura (10–14%), soft tissue (7–15%), and liver (5–15%).