Hetelekidis S, Schnitt S J, Silver B, Manola J, Bornstein B A, Nixon A J, Recht A, Gelman R, Harris J R, Connolly J L
Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA 02115, USA.
Int J Radiat Oncol Biol Phys. 2000 Jan 1;46(1):31-4. doi: 10.1016/s0360-3016(99)00424-1.
To investigate if extracapsular extension (ECE) of axillary lymph node metastases predicts for a decreased rate of disease-free survival or an increased rate of regional recurrence of breast carcinoma.
The study population consisted of 368 patients with T1 or T2 breast cancer and pathologically-positive lymph nodes treated with breast-conserving therapy between 1968 and 1986. The median number of sampled lymph nodes was 10. Median follow-up time for the surviving patients was 139 months (range 70-244). Twenty percent of the patients were treated with supraclavicular RT, and 64% received both axillary and supraclavicular RT, with a median dose to the nodes of 45 Gy. The following factors were evaluated: presence of ECE, number of sampled lymph nodes (LN), number of involved LN, size of primary tumor, histologic grade of tumor, presence of lymphatic vessel invasion (LVI), presence of an extensive intraductal component (EIC), radiation dose, use of adjuvant chemotherapy, and age of patient. Recurrences were reported as the 5-year crude sites of first failure, and were divided into breast recurrences (LR), regional nodal failure (RNF, defined as isolated axillary, supraclavicular, or internal mammary recurrence), and distant metastases (DM).
One hundred twenty-two patients (33%) had ECE and 246 patients did not. The median number of LN with ECE was 1 (range 1-10) and 20% of patients had ECE in > or =4 LN. Patients with ECE tended to be older (median age 51 vs. 47, p = 0.01), and had a higher number of involved LN (median 3 vs. 2, p = 0.005) than patients without ECE. Forty-three percent of patients with ECE had > or =4 involved LN compared to 15% of patients without ECE (p<0.0001). Models of ECE and the above factors revealed no significant correlation between ECE and either disease-free or overall survival. There was no statistically significant increase in local, regional nodal, or distant failures in patients with ECE as compared to patients without ECE.
In this population of patients with nodal involvement, the presence of ECE correlates with the number of involved LN but does not appear to add predictive power to models of local, regional, or distant recurrence when the number of positive LN is included.
探讨腋窝淋巴结转移的包膜外扩展（ECE）是否预示着乳腺癌无病生存率降低或区域复发率增加。
研究人群包括1968年至1986年间接受保乳治疗的368例T1或T2期乳腺癌且病理检查淋巴结阳性的患者。所取淋巴结的中位数为10个。存活患者的中位随访时间为139个月（范围70 - 244个月）。20%的患者接受了锁骨上放疗，64%的患者接受了腋窝和锁骨上放疗，淋巴结的中位剂量为45 Gy。评估了以下因素：ECE的存在、所取淋巴结数量（LN）、受累淋巴结数量、原发肿瘤大小、肿瘤组织学分级、淋巴管侵犯（LVI）的存在、广泛导管内成分（EIC）的存在、放疗剂量、辅助化疗的使用以及患者年龄。复发情况报告为首次失败的5年粗略部位，并分为乳腺复发（LR）、区域淋巴结失败（RNF，定义为孤立的腋窝、锁骨上或内乳复发）和远处转移（DM）。
122例患者（33%）有ECE，246例患者无ECE。有ECE的患者受累淋巴结的中位数为1个（范围1 - 10个），20%的患者在≥4个淋巴结中有ECE。有ECE的患者往往年龄较大（中位年龄分别为51岁和47岁，p = 0.01），且受累淋巴结数量较多（中位数分别为3个和2个，p = 0.005），高于无ECE的患者。有ECE的患者中43%有≥4个受累淋巴结，而无ECE的患者中这一比例为15%（p<0.0001）。ECE与上述因素的模型显示，ECE与无病生存率或总生存率之间无显著相关性。与无ECE 的患者相比，有ECE的患者在局部、区域淋巴结或远处失败方面无统计学上的显著增加。
在这群有淋巴结受累的患者中，ECE的存在与受累淋巴结数量相关，但当纳入阳性淋巴结数量时，它似乎并未增加对局部、区域或远处复发模型的预测能力。
