• 中國(guó)醫(yī)學(xué)科學(xué)院 北京協(xié)和醫(yī)學(xué)院 北京協(xié)和醫(yī)院乳腺外科（北京 100730）;

目的  探討我院近30年間乳腺癌治療及預(yù)后的變化趨勢(shì)。方法  統(tǒng)計(jì)我院1975～2006年6個(gè)時(shí)間段（1975～1980年、1985～1986年、1990～1991年、1995～1996年、2000～2001年及2005～2006年）1 092例乳腺癌患者的臨床資料，進(jìn)行以下比較： 各組手術(shù)、化療、放療及內(nèi)分泌治療情況及方案，復(fù)發(fā)轉(zhuǎn)移部位以及無(wú)瘤生存率。結(jié)果  1975～1980年以根治術(shù)為主(68.9%，91/132)，此后明顯減少，自2001年后基本未再應(yīng)用根治術(shù)； 改良根治術(shù)自1980年后逐漸增多，到1995～1996年達(dá)到最高峰（94.9%，146/154）； 保乳術(shù)及局部擴(kuò)大切除或乳房單純切除術(shù)自2000年開(kāi)始逐漸增多。化療患者從1985～1986年開(kāi)始逐漸增多。各時(shí)間段接受放療患者所占比例無(wú)明顯變化。1975～1980年僅有0.8%（1/126）的患者接受內(nèi)分泌治療，至1990～1991年有66.0%（33/50）的患者接受內(nèi)分泌治療。6個(gè)時(shí)間段的復(fù)發(fā)轉(zhuǎn)移率呈逐漸下降趨勢(shì)（P＜0.05）。后4個(gè)時(shí)間段（1990～1991年、1995～1996年、2000～2001及2005～2006年）的5年及10年無(wú)瘤生存率明顯高于前2個(gè)時(shí)間段（1975～1980年及1985～1986年），P＜0.05。結(jié)論  乳腺癌的治療遵循基礎(chǔ)及臨床試驗(yàn)的結(jié)論，能夠改善患者預(yù)后。

引用本文： 鐘穎,孫強(qiáng),徐雅莉,周易冬,茅楓,關(guān)競(jìng)紅,林燕. 30年乳腺癌治療趨勢(shì)的變化. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(11): 911-917. doi: 復(fù)制

1. Fremgen AM, Bland KI, McGinnis LS Jr, et al. Clinical highlights from the National Cancer Data Base, 1999 [Ｊ]. CA Cancer J Clin, 1999; 49(3): 145-158.
2. Halsted WS. A Clinical and Histological Study of certain Adenocarcinomata of the Breast: and a Brief Consideration of the Supraclavicular Operation and of the Results of Operations for Cancer of the Breast from 1889 to 1898 at the Johns Hopkins Hospital [Ｊ]. Ann Surg, 1898; 28(5): 557-576.
3. Halsted WS. The Results of Radical Operations for the Cure of Carcinoma of the Breast [Ｊ]. Ann Surg, 1907; 46(1): 1-19.
4. Fisher B, Fisher ER. Biologic aspects of cancer-cell spread [A]. In: Proceedings of the Fifth National Cancer Conference[C]. Philadelphia, Pennsylvania: Lippincott, 1965: 105-122.
5. Fisher B, Fisher ER. The biology of metastasis[A]. In: Davis JH eds. Current Concepts in Surgery [M]. New York: McGraw Hill, 1965: 321-351.
6. Fisher ER, Fisher B. Host-tumor relationship in the development and growth of hepatic metastases [A]. In: Wissler RW, Dao TL, Wood Jr S eds. Endogenous Factors Influencing Host-Tumor Balance [M]. Chicago: University of Chicago Press, 1967: 149-166.
7. Fisher B, Fisher ER. Metastases of cancer cells [A]. In: Busch H eds. Methods in Cancer Research [M]. New York: Academic Press, 1967: 243-286.
8. Fisher B. Laboratory and clinical research in breast cancer-a personal adventure: the David A. Karnofsky memorial lecture [Ｊ]. Cancer Res, 1980; 40(11): 3863-3874.
9. Fisher B. The interdependence of laboratory and clinical research in the study of metastases [A]. In: Nicolson GL, Miles L eds. Cancer Invasion and Metastasis: Biologic and Therapeutic Aspects [M]. New York: Raven Press, 1984: 27-46.
10. Fisher B, Redmond C, Fisher ER. Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation [Ｊ]. N Engl J Med, 1985; 312(11): 674-681.
11. National Surgical Adjuvant Breast and Bowel Project (NSABP). Progress Report [R]. July 1998: 17-23.
12. Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer [Ｊ]. N Engl J Med, 1995; 333(22): 1456-1461.
13. National Surgical Adjuvant Breast and Bowel Project (NSABP). Progress Report [R]. July 1998: 31-39.
14. 孫強(qiáng), 黃漢源, 周易冬, 等.　 X線立體定位乳腺活檢術(shù)的臨床應(yīng)用 [Ｊ]. 中國(guó)實(shí)用外科雜志, 2000; 20(5): 281-282.
15. Fisher ER, Turnbull RB Jr. The cytologic demonstration and significance of tumor cells in the mesenteric venous blood in patients with colorectal carcinoma [Ｊ]. Surg Gynecol Obstet, 1955; 100(1): 102-108.
16. Shapiro DM, Fugmann RA. A role for chemotherapy as an adjunct to surgery [Ｊ]. Cancer Res, 1957; 17(11): 1098-1101.
17. Fisher B, Carbone P, Economou SG, et al. 1-Phenylalanine mustard (L-PAM) in the management of primary breast cancer. A report of early findings [Ｊ]. N Engl J Med, 1975; 292(3): 117-122.
18. Bonadonna G, Brusamolino E, Valagussa P, et al. Combination chemotherapy as an adjuvant treatment in operable breast cancer [Ｊ]. N Engl J Med, 1976; 294(8): 405-410.
19. Polychemotherapy for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists’ Collaborative Group [Ｊ]. Lancet, 1998; 352(9132): 930-942.
20. Martin M, Pienkowski T, Mackey J, et al. Adjuvant docetaxel for node-positive breast cancer [Ｊ]. N Engl J Med, 2005; 352(22): 2302-2313.
21. Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial [Ｊ]. N Engl J Med, 1997; 337(14): 949-955.
22. Whelan TJ, Julian J, Wright J, et al. Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis A meta-analysis [Ｊ]. J Clin Oncol, 2000; 18(6): 1220-1229.
23. Recht A, Edge SB, Solin LJ, et al. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology [Ｊ]. J Clin Oncol, 2001; 19(5): 1539-1569.
24. Heuson JC. Current overview of EORTC clinical trials with tamoxifen [Ｊ]. Cancer Treat Rep, 1976; 60(10): 1463-1466.
25. Mouridsen H, Palshof T, Patterson J, et al. Tamoxifen in advanced breast cancer [Ｊ]. Cancer Treat Rev, 1978; 5(3): 131-141.
26. Legha SS, Buzdar AU, Hortobagyi GN, et al. Tamoxifen. Use in treatment of metastatic breast cancer refractory to combination chemotherapy [Ｊ]. JAMA, 1979; 242(1): 49-52.
27. Margreiter R, Wiegele J. Tamoxifen (Nolvadex) for premenopausal patients with advanced breast cancer [Ｊ]. Breast Cancer Res Treat, 1984; 4(1): 45-48.
28. Controlled trial of tamoxifen as adjuvant agent in management of early breast cancer. Interim analysis at four years by Nolvadex Adjuvant Trial Organisation [Ｊ]. Lancet, 1983; 1(8319): 257-261.
29. Controlled trial of tamoxifen as single adjuvant agent in management of early breast cancer. Analysis at six years by Nolvadex Adjuvant Trial Organisation [Ｊ]. Lancet, 1985; 1(8433): 836-840.
30. Adjuvant tamoxifen in the management of operable breast cancer: the Scottish Trial. Report from the Breast Cancer Trials Committee, Scottish Cancer Trials Office (MRC), Edinburgh [Ｊ]. Lancet, 1987; 2(8552): 171-175.
31. Fisher B, Costantino J, Redmond C, et al. A randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen-receptor-positive tumors [Ｊ]. N Engl J Med, 1989; 320(8): 479-484.
32. Fisher B, Dignam J, Bryant J, et al. Five versus more than five years of tamoxifen therapy for breast cancer patients with negative lymph nodes and estrogen receptor-positive tumors [Ｊ]. J Natl Cancer Inst, 1996; 88(21): 1529-1542.
33. Tamoxifen for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists’ Collaborative Group [Ｊ]. Lancet, 1998; 351(9114): 1451-1467.
34. Fisher B, Dignam J, Bryant J, et al. Five versus more than five years of tamoxifen for lymph node-negative breast cancer: updated findings from the National Surgical Adjuvant Breast and Bowel Project B-14 randomized trial [Ｊ]. J Natl Cancer Inst, 2001; 93(9): 684-690.
35. Aydiner A, Tas F. Meta-analysis of trials comparing anastrozole and tamoxifen for adjuvant treatment of postmenopausal women with early breast cancer [Ｊ]. Trials, 2008; 9: 47.
36. Crivellari D, Sun Z, Coates AS, et al. Letrozole compared with tamoxifen for elderly patients with endocrine-responsive early breast cancer: the BIG 1-98 trial [Ｊ]. J Clin Oncol, 2008; 26(12): 1972-1979.
  1. 1. Fremgen AM, Bland KI, McGinnis LS Jr, et al. Clinical highlights from the National Cancer Data Base, 1999 [Ｊ]. CA Cancer J Clin, 1999; 49(3): 145-158.
  2. 2. Halsted WS. A Clinical and Histological Study of certain Adenocarcinomata of the Breast: and a Brief Consideration of the Supraclavicular Operation and of the Results of Operations for Cancer of the Breast from 1889 to 1898 at the Johns Hopkins Hospital [Ｊ]. Ann Surg, 1898; 28(5): 557-576.
  3. 3. Halsted WS. The Results of Radical Operations for the Cure of Carcinoma of the Breast [Ｊ]. Ann Surg, 1907; 46(1): 1-19.
  4. 4. Fisher B, Fisher ER. Biologic aspects of cancer-cell spread [A]. In: Proceedings of the Fifth National Cancer Conference[C]. Philadelphia, Pennsylvania: Lippincott, 1965: 105-122.
  5. 5. Fisher B, Fisher ER. The biology of metastasis[A]. In: Davis JH eds. Current Concepts in Surgery [M]. New York: McGraw Hill, 1965: 321-351.
  6. 6. Fisher ER, Fisher B. Host-tumor relationship in the development and growth of hepatic metastases [A]. In: Wissler RW, Dao TL, Wood Jr S eds. Endogenous Factors Influencing Host-Tumor Balance [M]. Chicago: University of Chicago Press, 1967: 149-166.
  7. 7. Fisher B, Fisher ER. Metastases of cancer cells [A]. In: Busch H eds. Methods in Cancer Research [M]. New York: Academic Press, 1967: 243-286.
  8. 8. Fisher B. Laboratory and clinical research in breast cancer-a personal adventure: the David A. Karnofsky memorial lecture [Ｊ]. Cancer Res, 1980; 40(11): 3863-3874.
  9. 9. Fisher B. The interdependence of laboratory and clinical research in the study of metastases [A]. In: Nicolson GL, Miles L eds. Cancer Invasion and Metastasis: Biologic and Therapeutic Aspects [M]. New York: Raven Press, 1984: 27-46.
  10. 10. Fisher B, Redmond C, Fisher ER. Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation [Ｊ]. N Engl J Med, 1985; 312(11): 674-681.
  11. 11. National Surgical Adjuvant Breast and Bowel Project (NSABP). Progress Report [R]. July 1998: 17-23.
  12. 12. Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer [Ｊ]. N Engl J Med, 1995; 333(22): 1456-1461.
  13. 13. National Surgical Adjuvant Breast and Bowel Project (NSABP). Progress Report [R]. July 1998: 31-39.
  14. 14. 孫強(qiáng), 黃漢源, 周易冬, 等.　 X線立體定位乳腺活檢術(shù)的臨床應(yīng)用 [Ｊ]. 中國(guó)實(shí)用外科雜志, 2000; 20(5): 281-282.
  15. 15. Fisher ER, Turnbull RB Jr. The cytologic demonstration and significance of tumor cells in the mesenteric venous blood in patients with colorectal carcinoma [Ｊ]. Surg Gynecol Obstet, 1955; 100(1): 102-108.
  16. 16. Shapiro DM, Fugmann RA. A role for chemotherapy as an adjunct to surgery [Ｊ]. Cancer Res, 1957; 17(11): 1098-1101.
  17. 17. Fisher B, Carbone P, Economou SG, et al. 1-Phenylalanine mustard (L-PAM) in the management of primary breast cancer. A report of early findings [Ｊ]. N Engl J Med, 1975; 292(3): 117-122.
  18. 18. Bonadonna G, Brusamolino E, Valagussa P, et al. Combination chemotherapy as an adjuvant treatment in operable breast cancer [Ｊ]. N Engl J Med, 1976; 294(8): 405-410.
  19. 19. Polychemotherapy for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists’ Collaborative Group [Ｊ]. Lancet, 1998; 352(9132): 930-942.
  20. 20. Martin M, Pienkowski T, Mackey J, et al. Adjuvant docetaxel for node-positive breast cancer [Ｊ]. N Engl J Med, 2005; 352(22): 2302-2313.
  21. 21. Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial [Ｊ]. N Engl J Med, 1997; 337(14): 949-955.
  22. 22. Whelan TJ, Julian J, Wright J, et al. Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis A meta-analysis [Ｊ]. J Clin Oncol, 2000; 18(6): 1220-1229.
  23. 23. Recht A, Edge SB, Solin LJ, et al. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology [Ｊ]. J Clin Oncol, 2001; 19(5): 1539-1569.
  24. 24. Heuson JC. Current overview of EORTC clinical trials with tamoxifen [Ｊ]. Cancer Treat Rep, 1976; 60(10): 1463-1466.
  25. 25. Mouridsen H, Palshof T, Patterson J, et al. Tamoxifen in advanced breast cancer [Ｊ]. Cancer Treat Rev, 1978; 5(3): 131-141.
  26. 26. Legha SS, Buzdar AU, Hortobagyi GN, et al. Tamoxifen. Use in treatment of metastatic breast cancer refractory to combination chemotherapy [Ｊ]. JAMA, 1979; 242(1): 49-52.
  27. 27. Margreiter R, Wiegele J. Tamoxifen (Nolvadex) for premenopausal patients with advanced breast cancer [Ｊ]. Breast Cancer Res Treat, 1984; 4(1): 45-48.
  28. 28. Controlled trial of tamoxifen as adjuvant agent in management of early breast cancer. Interim analysis at four years by Nolvadex Adjuvant Trial Organisation [Ｊ]. Lancet, 1983; 1(8319): 257-261.
  29. 29. Controlled trial of tamoxifen as single adjuvant agent in management of early breast cancer. Analysis at six years by Nolvadex Adjuvant Trial Organisation [Ｊ]. Lancet, 1985; 1(8433): 836-840.
  30. 30. Adjuvant tamoxifen in the management of operable breast cancer: the Scottish Trial. Report from the Breast Cancer Trials Committee, Scottish Cancer Trials Office (MRC), Edinburgh [Ｊ]. Lancet, 1987; 2(8552): 171-175.
  31. 31. Fisher B, Costantino J, Redmond C, et al. A randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen-receptor-positive tumors [Ｊ]. N Engl J Med, 1989; 320(8): 479-484.
  32. 32. Fisher B, Dignam J, Bryant J, et al. Five versus more than five years of tamoxifen therapy for breast cancer patients with negative lymph nodes and estrogen receptor-positive tumors [Ｊ]. J Natl Cancer Inst, 1996; 88(21): 1529-1542.
  33. 33. Tamoxifen for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists’ Collaborative Group [Ｊ]. Lancet, 1998; 351(9114): 1451-1467.
  34. 34. Fisher B, Dignam J, Bryant J, et al. Five versus more than five years of tamoxifen for lymph node-negative breast cancer: updated findings from the National Surgical Adjuvant Breast and Bowel Project B-14 randomized trial [Ｊ]. J Natl Cancer Inst, 2001; 93(9): 684-690.
  35. 35. Aydiner A, Tas F. Meta-analysis of trials comparing anastrozole and tamoxifen for adjuvant treatment of postmenopausal women with early breast cancer [Ｊ]. Trials, 2008; 9: 47.
  36. 36. Crivellari D, Sun Z, Coates AS, et al. Letrozole compared with tamoxifen for elderly patients with endocrine-responsive early breast cancer: the BIG 1-98 trial [Ｊ]. J Clin Oncol, 2008; 26(12): 1972-1979.