RESUMEN
Between October 1977 and December 1983, 379 consecutive patients have been treated for unilateral, non metastatic breast cancer, either with conservative (n = 205) or radical surgery (n = 174), with axillary dissection in all the cases. None of them had histologically proved lymph node involvement. Adjuvant radiotherapy was given in 268 cases. Estrogen receptor (ER) and progesterone receptor (PR) levels were measured on each tumor. Levels greater than 5 fmoles/mg cytosolic protein were considered as positive for both ER and PR. At 5 years, overall survival (OS) and disease-free survival (DFS) are respectively 88% and 79%. Unifactorial analysis using KAPLAN and MEIER estimates and Logrank test revealed that OS was significantly related to age, tumor size, histopathological grading, ER and PR. DFS was significantly related to the same factors. Menopausal status, number of intra mammary tumor foci, previous familial history of breast cancer were not significant. Multifactorial analysis revealed that DFS was significantly related to age (bad prognosis [bp]: less than or equal to 37 years old), tumor size, histopathological grading (bp: SBR = 3) and that OS was significantly related to tumor size and PR (bp: PR less than or equal to 5 fmoles/mg protein). A prognostic score was obtained which sampled our patients into 3 significantly different (P less than 0.0001) groups with high, intermediate and low risk of relapse. These results suggest that tumor size, histopathological grading and PR have their own prognostic weight in histologically node negative breast cancer. Grouping these factors together allows to define a high risk relapse group that could benefit from adjuvant treatment.
Asunto(s)
Adenocarcinoma/mortalidad , Neoplasias de la Mama/mortalidad , Análisis Actuarial , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Pronóstico , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The diagnostic value of mammography was evaluated retrospectively in 23 recurrent carcinomas in patients previously treated by partial mastectomy with or without adjuvant radiotherapy. Mammography established accurate diagnosis in 11 of the 23 patients. Mammography should always be performed in addition to clinical and cytological examinations and results must be evaluated jointly. Confrontation of these three investigations may be inconclusive as a result of changes produced by radiotherapy or surgery. The authors recall the necessity of surgical control of any nodular lesion developed in the area of the initial operation, particularly during the first three years.
Asunto(s)
Neoplasias de la Mama/cirugía , Recurrencia Local de Neoplasia/diagnóstico , Biopsia con Aguja , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/radioterapia , Terapia Combinada , Femenino , Humanos , Mamografía , Estudios RetrospectivosRESUMEN
During surgery for carcinoma of the oesophagus, the authors emphasise the need for selective intubation using a Carlens tube, of avoiding damage to the diaphragm and the phrenic nerve at all levels, and of draining the hemithorax involved in the operation by three drains: anterior and posterior thoracic and madiastino-abdominal. These precautions reduce post-operative difficulties, justifiy excision surgery for carcinoma of the oesophagus, and to a certain extent make it possible to reduce the contraindications, in particular in the presence of tracheo-bronchial spread. Amongst 107 patients undergoing surgery, in whom there was a risk of respiratory insufficiency in one quarter, surgery (sometimes with extension of the excision: one case in four) was associated with an operative and post-operative mortality of 18%.