Cancer of the breast: Size of neoplasm and prognosis
Cancer of the breast: Size of neoplasm and prognosis
复制标题
乳腺癌：肿瘤的大小和预后
作者：
B. Fisher;N. Slack;I. Bross
在这项研究中，我们利用了从2000多名可手术的乳腺癌患者中获得的信息，这些患者自1957年以来被45个机构纳入了国家乳腺项目。目的是进一步评估乳腺肿瘤的大小影响患者预后的概念。只有5%的患者肿瘤小于1.0 cm，48%大于2.9 cm，28%超过4.0 cm。与其他人以前报道的结果相比，这些发现表明，自1950年以来，相对于切除较小的乳腺肿瘤，几乎没有取得进展。由于这些数据可能比大多数其他可用数据更能代表过去十年美国手术时乳腺肿瘤的大小，因此它们为评估各种最近采用和拟议的诊断程序的价值提供了基线。获得的结果与目前的观点完全一致，即肿瘤越大，腋窝淋巴结阳性的可能性越大，将涉及4个或更多而不是1 - 3个淋巴结，肿瘤复发率和死亡率将更高。然而，这样一个无条件的声明是对结果的过度简化，没有提供不同大小肿瘤的复发率和死亡率差异的程度的预期指标，只能有保留地接受。根据所提供的数据和某些假设，推测如果所有2.0 cm或更大的肿瘤（占总数的70%）在1.0 - 1.9 cm时被切除，则在5年结束时，所有入组患者的复发率可能仅降低10 - 18%，总生存率可能增加11 - 20%。从某些考虑和获得的结果，可以得出结论，大小可能不一定与肿瘤的“早期”或“晚期”有关，也不像其他因素那样与患者的命运有关，这些因素与肿瘤和/或宿主有关，可能从肿瘤开始就存在，并决定转移的发展。这样的结论并不反对对早期诊断和肿瘤切除的努力。然而，它确实强调，这种奋进的原因可能与目前普遍认为的原因不同。
In this study we utilized information obtained from more than 2000 operable breast cancer patients who had been entered since 1957 into the National Breast Project by 45 institutions. The purpose was to further evaluate the concept that the size of breast neoplasms influences patient prognosis. Only 5% of patients had tumors smaller than 1.0 cm, 48% were larger than 2.9 cm, and 28% exceeded 4.0 cm. The findings, when compared with those previously reported by others, suggest that little progress has been made since about 1950 relative to the removal of smaller breast tumors. Since these data are probably more nearly representative of the size of breast tumors at surgery in this country during the past decade than most other data that are available, they provide a baseline for the evaluation of the worth of a variety of recently employed and proposed diagnostic procedures. Results obtained categorically agree with current thinking that the larger the tumor the more likely that axillary nodes will be positive, that 4 or more rather than 1‐3 nodes will be involved, and tumor recurrence and mortality rates will be greater. Such an unqualified statement, however, is an oversimplification of the findings, provides no indication of the magnitude of recurrence and mortality differences to be anticipated from tumors of various sizes, and should be accepted only with reservation. It is speculated, as a result of the data presented and certain assumptions, that if all tumors 2.0 cm or larger (70% of the total) had been removed when they were 1.0‐1.9 cm in size, at the end of 5 years the recurrence rate for all patients entered might have only decreased by 10‐18%, and the overall survival might have increased 11‐20%. From certain considerations and the results obtained, it is concluded that size may not necessarily relate to “earliness” or “lateness” of a tumor, nor is it as consequential to the fate of the patient as are other factors relative to the tumor and /or host that may be present from its inception and which determine the development of metastases. Such a conclusion does not deprecate effort toward earlier diagnosis and tumor removal. It does emphasize, however, that the reasons for such an endeavor may be different from those generally considered at present.