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目的对区域淋巴结阴性乳腺癌的术后辅助治疗目前存在争议，本研究试从卫生经济学角度为该组患者的临床治疗提供参考。方法选取上海医科大学肿瘤医院１９８８年１月１日至１９９３年１２月１日手术的ＰＴ２Ｎ０Ｍ０的乳腺癌患者共１７２例，按单手术（Ｓ）、术后加三苯氧胺（Ｓ＋Ｔ）、术后加ＣＭＦ辅助化疗（Ｓ＋Ｃ）、术后加三苯氧胺及ＣＭＦ辅助化疗（Ｓ＋Ｔ＋Ｃ）分４组，计算各组５年无瘤生存率（ＤＦＳ）及各组平均每例患者总的费用，后者包括医疗费及误工费。结果Ｓ、Ｓ＋Ｔ、Ｓ＋Ｃ、Ｓ＋Ｔ＋Ｃ４组５年ＤＦＳ分别为９１．３％、９２．９％、８５．９％、８７．８２％（Ｐ＝０．６９１４），而平均每例总费用４组分别为１７７０．４６元、２８１６．８１元、３５２９．５５元、４０８１．９９元（Ｐ＝０．００００）（折算至１９８８年物价水平）。结论无选择性应用术后辅助治疗并不能提高ＰＴ２Ｎ０Ｍ０乳腺癌患者的５年ＤＦＳ及可能的长期生存率，并造成不必要的经济损失及患者生活质量的影响。选择有较高复发危险性的ＰＴ２Ｎ０Ｍ０乳腺癌患者行必要的术后辅助治疗是提高疗效的有效措施。
Objectives There are controversies regarding postoperative adjuvant therapy of regional lymph node negative breast cancer. This study will provide reference for the clinical treatment of this group of patients from the perspective of health economics. Methods A total of 172 breast cancer patients with PT2N0M0 who were operated on from January 1, 1988 to December 1, 1993 at the Shanghai Cancer Center of Shanghai Medical University were enrolled. The patients were treated with single surgery (S), postoperative tamoxifen (S+T), and CMF after surgery. Adjuvant chemotherapy (S+C), postoperative addition of tamoxifen and CMF adjuvant chemotherapy (S+T+C) were divided into 4 groups to calculate the 5-year disease-free survival rate (DFS) of each group and the average cost of each patient in each group. The latter included medical expenses and Loss of work. Results The 5-year DFS of the S, S+T, S+C, S+T+C4 groups was 91.3%, 92.9%, 85.9%, and 87.82% (P=0.6914), respectively, and the average cost per case was 4 groups. It was 1770.46 yuan, 2816.81 yuan, 3529.55 yuan, and 4081.99 yuan (P=0.0000) (converted to the price level in 1988). Conclusions The non-selective use of postoperative adjuvant therapy does not improve 5-year DFS and possible long-term survival of patients with PT2N0M0 breast cancer, and causes unnecessary economic losses and the quality of life of patients. Selecting necessary postoperative adjuvant therapy for PT2N0M0 breast cancer patients with high risk of recurrence is an effective measure to improve the efficacy.