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收缩性心力衰竭与非收缩性心力衰竭危险性相当

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美国医学会杂志（中文版） 2007年第6期26卷 360-361页

作者： per hildebrandt 靳文英（译）陈红（校） Departments of Medicine and Cardiology Roskilde University Hospital Roskilde Denmark 不详

心力衰竭是一种发病率逐年增长的常见病，估计美国每年约有110万人因心力衰竭入院。尽管患者应用了包括β-阻滞剂、血管紧张素转化酶抑制剂、安体舒通、各种除颤器等在内的有效治疗措施，但是心力衰竭仍然是一种预后很差的严重疾患。

关键词：收缩性心力衰竭血管紧张素转化酶抑制剂 β-阻滞剂安体舒通有效治疗常见病发病率除颤器

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心血管疾病死亡风险预测随着亚临床器官损害标记物的增加而提高

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中华高血压杂志 2010年第6期18卷 599-599页

作者：沈逸华谢良地 Thomas Sehestedt Jorgen Jeppesen Tine W.Hansen Kristian Wachtell Hans Ibsen Christian Torp-Petersen per hildebrandt Michael H.Olsen

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Axillary Surgery in Breast Cancer - Primary Results of the INSEMA Trial

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The New England journal of medicine 2024年第12期46卷 2024 Dec 12页

作者： Toralf Reimer Angrit Stachs Kristina Veselinovic Thorsten Kühn Jörg Heil Silke Polata Frederik Marmé Thomas Müller Guido hildebrandt David Krug Beyhan Ataseven Roland Reitsamer Sylvia Ruth Carsten Denkert Inga Bekes Dirk-Michael Zahm Marc Thill Michael Golatta Johannes Holtschmidt Michael Knauer Valentina Nekljudova Sibylle Loibl Bernd Gerber From the Department of Obstetrics and Gynecology University of Rostock Rostock Germany (T.R. A.S. B.G.) University Hospital Ulm Ulm Germany (K.V. I.B.) Hospital Esslingen Esslingen Germany (T.K.) University Hospital Heidelberg Heidelberg Germany (J. Heil M.G.) the Breast Unit Sankt Elisabeth Hospital Heidelberg Germany (J. Heil M.G.) Evang. Waldkrankenhaus Spandau Berlin (S.P.) the Faculty of Medicine Mannheim Department of Obstetrics and Gynecology University of Heidelberg Mannheim Germany (F.M.) the Department of Obstetrics and Gynecology Hanau City Hospital Hanau Germany (T.M.) the Department of Radiation Oncology University Hospital Rostock Rostock Germany (G.H.) the Department of Radiotherapy and Radiation Oncology University Hospital Hamburg-Eppendorf (UKE) Hamburg Germany (D.K.) the Department of Radiation Oncology University Medical Center Schleswig-Holstein Kiel Germany (D.K.) Medical School and University Medical Center OWL Department of Gynecology and Obstetrics Bielefeld University Klinikum Lippe Detmold Germany (B.A.) Salzburg Regional Hospital Salzburg Austria (R.R.) Johanniter-Hospital Genthin-Stendal Genthin Germany (S.R.) the Institute of Pathology Philipps-University Marburg and University Hospital Marburg (UKGM) Marburg Germany (C.D.) Breast Center St. Gallen Kantonsspital St. Gallen Switzerland (I.B.) SRH Wald-Klinikum Gera Gera Germany (D.-M.Z.) the Department of Gynecology and Gynecologic Oncology Agaplesion Markus Hospital Frankfurt am Main Germany (M.T.) the German Breast Group Neu-Isenburg Germany (J. Holtschmidt V.N. S.L.) and the Tumor and Breast Center Eastern Switzerland St. Gallen Switzerland (M.K.).

BACKGROUND:Whether surgical axillary staging as part of breast-conserving therapy can be omitted without compromising survival has remained unclear.METHODS:In this prospective, randomized, noninferiority trial, we investigated the omission of axillary surgery as compared with sentinel-lymph-node biopsy in patients with clinically node-negative invasive breast cancer staged as T1 or T2 (tumor size, ≤5 cm) who were scheduled to undergo breast-conserving surgery. We report here the per-protocol analysis of invasive disease-free survival (the primary efficacy outcome). To show the noninferiority of the omission of axillary surgery, the 5-year invasive disease-free survival rate had to be at least 85%, and the upper limit of the confidence interval for the hazard ratio for invasive disease or death had to be below 1.271.RESULTS:A total of 5502 eligible patients (90% with clinical T1 cancer and 79% with pathological T1 cancer) underwent randomization in a 1:4 ratio. The per-protocol population included 4858 patients; 962 were assigned to undergo treatment without axillary surgery (the surgery-omission group), and 3896 to undergo sentinel-lymph-node biopsy (the surgery group). The median follow-up was 73.6 months. The estimated 5-year invasive disease-free survival rate was 91.9% (95% confidence interval [CI], 89.9 to 93.5) among patients in the surgery-omission group and 91.7% (95% CI, 90.8 to 92.6) among patients in the surgery group, with a hazard ratio of 0.91 (95% CI, 0.73 to 1.14), which was below the prespecified noninferiority margin. The analysis of the first primary-outcome events (occurrence or recurrence of invasive disease or death from any cause), which occurred in a total of 525 patients (10.8%), showed apparent differences between the surgery-omission group and the surgery group in the incidence of axillary recurrence (1.0% vs. 0.3%) and death (1.4% vs. 2.4%). The safety analysis indicates that patients in the surgery-omission group had a lower incidence

关键词： trial surgery axillary breast cancer-primary insema results

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