Bolwell B, Andresen S, Pohlman B, Sobecks R, Goormastic M, Rybicki L, Bell K, Kalaycio M
Department of Hematology and Medical Oncology, and Transplant Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Bone Marrow Transplant. 2001 Apr;27(8):843-6. doi: 10.1038/sj.bmt.1703004.
The role of autologous peripheral blood progenitor cell (PBPC) transplantation for high-risk stage II/III breast cancer remains controversial. New prognostic indicators defining subsets of patients who may benefit from autologous PBPC transplantation would be clinically useful. The axillary lymph node ratio, defined by the total number of axillary nodes involved with cancer divided by the number of axillary nodes surgically sampled, has been reported to be of potential prognostic importance in transplantation for high-risk, stage II/III breast cancer. We therefore retrospectively reviewed 111 women with high-risk, stage II/III breast cancer with at least four positive axillary lymph nodes undergoing autologous PBPC transplantation from 1991 to June 1999. None of the patients had received prior radiotherapy and all had completed one, and only one, course of at least three cycles of adjuvant chemotherapy. The median number of axillary nodes sampled was 20 (range 6-40) and the median number of positive axillary nodes was 12 (range 4-35). The median node ratio, dividing the number of positive nodes by the number of sampled nodes, was 0.68. Event-free survival was strongly influenced by node ratio. Patients having a node ratio of < 0.7 had a 5-year event-free survival of 68%, vs those with a node ratio of > or = 0.7 with a 5-year event-free survival of 46% (P = 0.03). Forty percent of patients with a high node ratio have relapsed vs 20% with a low node ratio (P = 0.02). Multivariate analysis revealed that positive estrogen receptor status and a node ratio of < 0.7 were independent factors related to better event-free survival (P = 0.0001 and P = 0.004, respectively). We conclude that patients having a node ratio of < 0.7 have a significantly better prognosis following autologous PBPC transplantation than do patients with a ratio > or = 0.7.
自体外周血祖细胞（PBPC）移植在高危II/III期乳腺癌治疗中的作用仍存在争议。确定哪些患者亚组可能从自体PBPC移植中获益的新预后指标将具有临床实用价值。腋窝淋巴结比率由受累腋窝淋巴结总数除以手术取样的腋窝淋巴结数定义，据报道，在高危II/III期乳腺癌移植中具有潜在的预后重要性。因此，我们回顾性分析了1991年至1999年6月期间111例高危II/III期乳腺癌且至少有4个腋窝阳性淋巴结并接受自体PBPC移植的女性患者。所有患者均未接受过放疗，且均完成了至少三个周期辅助化疗中的一个且仅一个疗程。手术取样的腋窝淋巴结中位数为20个（范围6 - 40个），腋窝阳性淋巴结中位数为12个（范围4 - 35个）。阳性淋巴结数除以取样淋巴结数所得的淋巴结比率中位数为0.68。无事件生存期受淋巴结比率的强烈影响。淋巴结比率<0.7的患者5年无事件生存率为68%，而淋巴结比率≥0.7的患者5年无事件生存率为46%（P = 0.03）。淋巴结比率高的患者中有40%复发，而淋巴结比率低的患者为20%（P = 0.02）。多因素分析显示，雌激素受体阳性状态和淋巴结比率<0.7是与更好的无事件生存期相关的独立因素（分别为P = 0.0001和P = 0.004）。我们得出结论，淋巴结比率<0.7的患者自体PBPC移植后的预后明显优于比率≥0.7的患者。
