A perspective concerning the relation of duration of symptoms to treatment failure in patients with breast cancer
A perspective concerning the relation of duration of symptoms to treatment failure in patients with breast cancer
复制标题
关于乳腺癌患者症状持续时间与治疗失败关系的观点
作者：
E. Fisher;C. Redmond;B. Fisher
在1,539例临床I期和II期浸润性癌症患者中，对症状持续时间与7个临床和33个组织学特征之间的相关性进行了测量。当症状持续时间超过9个月时，高度恶性（组织学3级）癌症和肿瘤坏死的相对频率降低。然而，随着症状持续时间的延长，肿瘤大小、临床II期疾病、乳头受累和覆盖肿瘤的皮肤受累的显微镜证据显著增加。腋窝淋巴结转移的患者比例与症状持续时间呈负相关。尽管症状的持续时间与这些不祥的预后指标有关，但其与平均每月治疗失败率的总体相关性在统计学上并不显著。事实上，在症状期超过9个月的患者中，治疗失败率有降低的趋势。生命表和平均每月治疗失败率的进一步分析结果证实了治疗失败率与症状持续时间之间总体缺乏相关性，这些分析试图评估这些判别因素与症状持续时间和治疗失败的相互关系。这些信息反映了肿瘤特征的异质性，可能也反映了宿主-肿瘤关系在乳腺癌患者自然史中的重要性。尽管这些考虑并不是要贬低乳腺癌早期诊断的良好实践，但它们确实表明，关于其生长和传播的时间导向的传统观点可能代表了误导性的过度简化。Cancer 40：3160 - 3167，1977.
Measures of association between the duration of symptoms and 7 clinical and 33 histologic characteristics in 1,539 patients with clinical stage I and II invasive cancer were performed. The relative frequency of highly malignant (histologic grade 3) cancers and tumor necrosis decreased when the duration of symptoms exceeded 9 months. However, tumor size, clinical stage II disease, nipple involvement, and microscopic evidence of involvement of the skin overlying the tumor were significantly increased with longer periods of duration of symptoms. The proportion of patients with axillary nodes containing metastases was suggestively related to duration of symptoms. Despite the relationship of duration of symptoms to these ominous prognostic indices its overall correlation with average monthly treatment failure rate was not statistically significant. Indeed, there was a trend toward a reduction in treatment failure rate in patients whose symptom period was greater than 9 months. The overall lack of association between treatment failure rate and duration of symptoms was sub‐stantiated by the results of further analyses of life tables and average monthly treatment failure rates which attempted to assess the interrelationships of these discriminants with duration of symptoms and treatment failure. This information reflects the heterogeneity of tumor characteristics and possibly the importance of host‐tumor relationships in the natural history of patients with breast cancer. Although these considerations are not intended to denigrate the sound practice of early diagnosis of breast cancer they do indicate that the time‐oriented, conventional view concerning its growth and dissemination may represent a misleading oversimplification. Cancer 40:3160‐3167, 1977.