Hasebe Takahiro, Sasaki Satoshi, Imoto Shigeru, Ochiai Atsushi
Pathology Division, National Cancer Center Research Institute East, Kashiwa, Chiba 277-8577, Japan.
Cancer Sci. 2003 Jun;94(6):508-14. doi: 10.1111/j.1349-7006.2003.tb01474.x.
No studies have ever precisely investigated the mechanism of nodal metastasis based on the histological characteristics of tumor cells in lymph vessels and lymph nodes. The purpose of this study was to investigate whether the histological characteristics of tumor cells in lymph vessels and lymph nodes of 393 patients with invasive ductal carcinoma (IDC) were significantly associated with increased nodal metastasis compared with well known histological characteristics of their primary-invasive tumor cells. Multivariate analyses showed that having a single nodal metastasis was closely dependent on primary-invasive tumor size or distance of lymph vessel tumor emboli from the margin of the primary-invasive tumor (P < 0.05) and that having 2 or more nodal metastases was significantly associated with the histological characteristics of the nodal metastatic tumors independently of the size of the primary-invasive tumor, and the number of nodes with extra-nodal invasion (ENI) significantly increased the relative risk (RR) of 4 or more nodal metastases in IDCs </= 20 mm and > 20 to </= 50 mm in size (P < 0.05). In IDCs > 50 mm in size, number of lymph vessels invaded, severe fibrosis of the stroma of extra-nodal invasive tumors, and distance of ENI from the node significantly increased the RR of 10 or more nodal metastases in the multivariate analysis (P < 0.05). The results of this study strongly suggest that the histological characteristics of tumor cells in lymph nodes and lymph vessels play an important role in nodal metastasis in IDCs of the breast.
以往尚无研究基于淋巴管和淋巴结中肿瘤细胞的组织学特征精确探究淋巴结转移机制。本研究旨在调查393例浸润性导管癌（IDC）患者淋巴管和淋巴结中肿瘤细胞的组织学特征与已知原发性浸润性肿瘤细胞的组织学特征相比，是否与淋巴结转移增加显著相关。多因素分析显示，发生单个淋巴结转移密切依赖于原发性浸润性肿瘤大小或淋巴管肿瘤栓子距原发性浸润性肿瘤边缘的距离（P<0.05），发生2个或更多淋巴结转移与淋巴结转移性肿瘤的组织学特征显著相关，而与原发性浸润性肿瘤大小无关，且结外侵犯（ENI）的淋巴结数量显著增加了大小≤20mm和>20至≤50mm的IDC发生4个或更多淋巴结转移的相对风险（RR）（P<0.05）。在大小>50mm的IDC中，多因素分析显示，被侵犯的淋巴管数量、结外浸润性肿瘤间质的严重纤维化以及ENI距淋巴结的距离显著增加了发生10个或更多淋巴结转移的RR（P<0.05）。本研究结果强烈提示，淋巴结和淋巴管中肿瘤细胞的组织学特征在乳腺IDC的淋巴结转移中起重要作用。
