T1至T3期肿瘤且经细胞学证实有腋窝转移性淋巴结的乳腺癌患者在接受初次化疗后腋窝完全降期的发生率及预后意义。

Incidence and prognostic significance of complete axillary downstaging after primary chemotherapy in breast cancer patients with T1 to T3 tumors and cytologically proven axillary metastatic lymph nodes.

作者信息

Rouzier Roman, Extra Jean-Marc, Klijanienko Jerzy, Falcou Marie-Christine, Asselain Bernard, Vincent-Salomon Anne, Vielh Philippe, Bourstyn Edwige

机构信息

Department of Surgery, Institut Curie, Paris, France.

出版信息

J Clin Oncol. 2002 Mar 1;20(5):1304-10. doi: 10.1200/JCO.2002.20.5.1304.

DOI:10.1200/JCO.2002.20.5.1304

PMID:11870173

Abstract

PURPOSE

To determine the incidence and prognostic significance of eradication of cytologically proven axillary lymph node metastases in breast cancer patients treated with primary chemotherapy.

PATIENTS AND METHODS

Between January 1985 and December 1994, 152 breast cancer patients with invasive T1 to T3 tumors and axillary metastases cytologically proven by fine-needle sampling underwent primary chemotherapy followed by lumpectomy or mastectomy, level I and II axillary lymph node dissection, and irradiation. We studied pathologic complete responses (pCRs) of axillary nodes and breast tumors, as well as predictors of distant metastases.

RESULTS

Thirty-five patients (23%) had axillary pCRs, and 20 patients (13.2%) had pCRs of primary breast tumors. Scarff-Bloom-Richardson grade 3 tumors (P =.04) and a clinical response to chemotherapy > or = 50% (P =.003) were associated with negative axillary status at dissection. An initial tumor size < or = 3 cm (63 patients) was associated with pCR of the primary tumor (P =.02) but not with complete histologic clearance of axillary lymph nodes. The median length of follow-up was 75 months. In the univariate analysis, age greater than 40 years (P =.003), absence of residual nodal disease (P =.01), and pCR of the tumor (P =.05) were associated with better distant disease-free survival. Five-year distant disease-free survival rates were 73.5% +/- 14.9% among patients with no involved nodes at the time of surgery and 48.7% +/- 9.2% among patients with residual nodal disease. In the multivariate Cox regression analysis, parameters associated with poor distant disease-free survival were age < or = 40 years (P =.002), persistence of nodal involvement (P =.03), and S-phase fraction greater than 4% (P =.02).

CONCLUSION

Our results suggest that axillary status is a better prognostic factor than response of the primary tumor to primary chemotherapy.

摘要

目的

确定在接受原发性化疗的乳腺癌患者中，经细胞学证实的腋窝淋巴结转移灶被清除的发生率及其预后意义。

患者与方法

1985年1月至1994年12月期间，152例患有浸润性T1至T3肿瘤且经细针穿刺取样细胞学证实有腋窝转移的乳腺癌患者接受了原发性化疗，随后进行肿块切除术或乳房切除术、Ⅰ级和Ⅱ级腋窝淋巴结清扫术以及放疗。我们研究了腋窝淋巴结和乳腺肿瘤的病理完全缓解（pCR）情况以及远处转移的预测因素。

结果

35例患者（23%）腋窝达到pCR，20例患者（13.2%）原发性乳腺肿瘤达到pCR。斯卡夫-布卢姆-理查森3级肿瘤（P = 0.04）以及化疗临床缓解率≥50%（P = 0.003）与清扫时腋窝状态阴性相关。初始肿瘤大小≤3 cm（63例患者）与原发性肿瘤的pCR相关（P = 0.02），但与腋窝淋巴结的完全组织学清除无关。中位随访时间为75个月。在单因素分析中，年龄大于40岁（P = 0.003）、无残留淋巴结疾病（P = 0.01）以及肿瘤pCR（P = 0.05）与更好的远处无病生存率相关。手术时无受累淋巴结的患者5年远处无病生存率为73.5%±14.9%，有残留淋巴结疾病的患者为48.7%±9.2%。在多因素Cox回归分析中，与远处无病生存率差相关的参数为年龄≤40岁（P = 0.002）、淋巴结受累持续存在（P = 0.03）以及S期分数大于4%（P = 0.02）。