VALUE OF AXILLARY DISSECTION IN ADDITION TO LUMPECTOMY AND RADIOTHERAPY IN EARLY BREAST-CANCER
VALUE OF AXILLARY DISSECTION IN ADDITION TO LUMPECTOMY AND RADIOTHERAPY IN EARLY BREAST-CANCER
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DOI：
10.1016/0140-6736(92)91591-u
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发表时间：
1992-05-23
期刊：
影响因子：
168.9
通讯作者：
ASSELAIN, B
中科院分区：
文献类型：
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作者：
CABANES, PA;SALMON, RJ;ASSELAIN, B
早期乳腺癌的腋窝淋巴结清扫术仍有争议，因为它的大量副作用，因为它的价值方面的复发或生存尚未得到明确的证明。在1982年至1987年期间，658例患者被纳入一项前瞻性随机对照研究，比较单纯乳房肿瘤切除术与乳房肿瘤切除术加腋窝淋巴结清扫术。所有患者均为单侧乳腺肿瘤，直径不超过3 cm，淋巴结受累或转移。两组患者均接受放射治疗，两组患者的平均年龄、TNM分期和激素受体的存在相似。中位随访时间为54个月。5-术后1年生存率为94.2%（95%CI：92.1-96.4）。腋窝淋巴结清扫组的生存率有显著优势（p = 0.014）。两组乳腺肿瘤复发率相似，但腋窝淋巴结清扫组内脏转移、锁骨上转移和淋巴结复发率较低。生存率与患者年龄（p = 0.005）、阳性淋巴结（p = 0.006）、组织学分级（p < 0.0001）和激素受体（孕酮p = 0.0008，雌激素p < 0.0001）有关。治疗调整的相对危险度为2.4（95%CI：1.3-4.2）。研究结果表明，腋窝淋巴结清扫术是治疗小乳腺癌的合理方法，尽管尚不清楚其生存率的提高是由于腋窝淋巴结清扫术本身还是由于淋巴结转移的辅助治疗。
Axillary dissection in early breast cancer remains controversial because of its substantial side-effects and because its value with respect to recurrence or survival has not been unequivocally proven. Between 1982 and 1987, 658 patients were included in a prospective randomised comparison of lumpectomy alone with lumpectomy plus axillary dissection. All patients had a unilateral breast tumour not exceeding 3 cm in diameter and lymph-node involvement or metastases. Radiation therapy was given to both groups.The two groups of patients were similar with respect to mean age, TNM stage, and presence of hormonal receptors. Median follow-up was 54 months. 5-year survival of the patients was 94.2% (95% Cl: 92.1-96.4). There was a significant advantage in survival in the axillary dissection group (p = 0.014). Recurrence of tumour in the breast was similar in the two groups but visceral metastases, supraclavicular metastases, and lymph-node recurrences were less frequent in the axillary dissection group. Survival was related to the age of the patients (p = 0.005), the presence of positive nodes (p = 0.006), the histological grading (p < 0.0001), and the presence of hormonal receptors (progesterone p = 0.0008, oestrogen p < 0.0001). Treatment-adjusted relative risk was 2.4 (95% Cl: 1.3-4.2).The findings show that axillary dissection is justified for treatment of small breast cancers, although whether the better survival is due to axillary clearance itself or to adjuvant treatment for lymph-node involvement is unclear.