Der Operationszeitpunkt beim prämenopausalen Mammakarzinom - Einfluß auf die Prognose?

Autor: Hans K. Weitzel, A. Hagen, U. Torsten, W. J. M. Hrushesky
Rok vydání: 1998
Předmět:
Zdroj: Geburtshilfe und Frauenheilkunde. 58:282-289
ISSN: 1438-8804
0016-5751
Popis: Purpose: The overall purpose of this exercise is to rigorously determine the relative strenght of the hypothesis that the menstrual cycle timing of operation has an impact on the outcome and to determine whether or not a specific change in the practice of breast surgical oncology can be recommended. Method: In 1989 preliminary results of a retrospective study were published which identified the timing of breast cancer surgery in relation to the menstrual cycle as an independent predictor of disease-free survival. At least dozens of reports have subsequently appeared, some supporting and others refuting the claim. This is a critical review of the outcomes of 8632 women published since 1989 in 31 retrospective studies, relevant to the possibility that the timing of primary breast cancer resection within the menstrual cycle impacts on breast cancer recurrence and/or patient survival. This article contrasts the adequacy of information and data analysis presented in each publication. Therefore we constructed an objective score for evaluating the quality of data. This score consists of the most relevant parameters, necessary to clarify the problem. Results: 14 studies including 3236 patients have reported, that the time of breast cancer resection during the menstrual cycle has an impact on the outcome. 17 retrospective studies with 5396 patients cannot confirm an influence of surgery timing on the prognosis in premenopausal breast cancer patients. A comparison of the quality of data among these studies demonstrates great variability. Arbitrary bisections of the menstrual cycle, the application of vastly different primary and adjuvant treatment strategies, the cumulative distribution (distribution function) of tumour stage of disease at diagnosis, duration of follow-up and the methods and precision of data analysis all differ markedly. Eight high-quality studies have been most completely reported. While two of these find no impact, six (75%) of these studies find that breast cancer outcome is affected by operative timing. The design of two ongoing prospective studies is considered inadequate. Conclusion: Although it is likely that the menstrual cycle phase of operation is relevant to outcome, the nature of the available data does not permit a clear recommendation in respect of the timing of operation. Hence, it is concluded that current retrospective data are insufficient to recommend an immediate change in practice. Prospective studies of this potentially important question are essential. The minimal requirements for adequate prospective study are outlined. Three elements seem to be essential, namely: the accurate triangulation of surgery within the cycle, temporal coordination of multiple surgical procedures if more than one operation is employed, and the investigation of menstrual cycle-coordinated biological functions potentially relevant to breast cancer resection outcome.
Databáze: OpenAIRE
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