Reed D N, Johnson J, Richard P, McCormick S, Shannon N, Mikhail R A, Osuch J, Cerrito P B, McMasters K M
Department of Surgery, Michigan State University College of Human Medicine, PO Box 115, Flint, MI 48501-0115, USA.
Arch Surg. 2000 Dec;135(12):1422-6. doi: 10.1001/archsurg.135.12.1422.
A small proportion of T1 or T2 node-negative breast cancer tumors will recur in patients by 5 years, and more by 10 years. Results of recent studies have suggested improvement in overall survival with administration of adjuvant chemotherapy to all patients. More sensitive and specific methods are needed to identify patients at highest risk for recurrence who might benefit most from adjuvant therapy, saving others from unnecessary treatment. Some investigators have suggested DNA flow cytometry as a method to discriminate patients at greatest risk for recurrence.
DNA flow cytometry has predictive value for breast cancer recurrence in node-negative patients.
The cancer registry of a medium-sized university-affiliated hospital was used to identify patients with T1-2 N0 M0 breast cancer treated with a uniform surgical approach and no adjuvant therapy who had completed at least 5 years of follow-up or had recurrence. Flow cytometric analysis was performed on paraffin-embedded specimens.
Of 115 patients, 92 (80%) had disease-free survival without recurrence and 23 (20%) had recurrence. Comparison of diploid and nondiploid tumors for likelihood of recurrence revealed no association (P = .79). Furthermore, the DNA index and S-phase fraction were not significantly different between recurrent and nonrecurrent groups.
The likelihood of recurrence of small node-negative breast cancers after mastectomy cannot be accurately predicted on the basis of DNA flow cytometric analysis. Traditional methods for determining risks-such as nuclear and histological grade, lymph node status, and tumor size-seem to be more useful. Sentinel lymph node biopsy techniques may increase the detection of micrometastases.
一小部分T1或T2期且淋巴结阴性的乳腺癌患者在5年内会复发，10年内复发的更多。近期研究结果表明，对所有患者进行辅助化疗可提高总生存率。需要更敏感和特异的方法来识别复发风险最高且可能从辅助治疗中获益最大的患者，使其他患者避免不必要的治疗。一些研究者建议将DNA流式细胞术作为一种区分复发风险最高患者的方法。
DNA流式细胞术对淋巴结阴性患者的乳腺癌复发具有预测价值。
利用一所中型大学附属医院的癌症登记系统，识别采用统一手术方法且未接受辅助治疗、已完成至少5年随访或已复发的T1-2 N0 M0期乳腺癌患者。对石蜡包埋标本进行流式细胞术分析。
115例患者中，92例（80%）无病生存未复发，23例（20%）复发。比较二倍体和非二倍体肿瘤的复发可能性，未发现相关性（P = 0.79）。此外，复发组和未复发组之间的DNA指数和S期分数无显著差异。
基于DNA流式细胞术分析不能准确预测乳房切除术后小的淋巴结阴性乳腺癌的复发可能性。传统的风险评估方法，如核分级和组织学分级、淋巴结状态和肿瘤大小，似乎更有用。前哨淋巴结活检技术可能会增加微转移的检出率。
