Foulkes William D, Metcalfe Kelly, Hanna Wedad, Lynch Henry T, Ghadirian Parviz, Tung Nadine, Olopade Olofunmilayo, Weber Barbara, McLennan Jane, Olivotto Ivo A, Sun Ping, Chappuis Pierre O, Bégin Louis R, Brunet Jean-Sébastien, Narod Steven A
Department of Oncology, McGill University, Montreal, Quebec, Canada.
Cancer. 2003 Oct 15;98(8):1569-77. doi: 10.1002/cncr.11688.
A positive correlation between breast tumor size and the number of axillary lymph nodes containing tumor is well established. It has been reported that patients with BRCA1-related breast carcinoma are more likely than patients with nonhereditary breast carcinoma to have negative lymph node status. Therefore, the authors questioned whether the known positive correlation between tumor size and lymph node status also was present in women with BRCA1-related breast carcinomas.
The relation between the greatest dimension of the resected breast tumor (size) and the presence of positive axillary lymph nodes (expressed as a percentage of all lymph nodes examined) was evaluated in 1555 women with invasive breast carcinoma who were ascertained at 10 centers in North America between 1975 and 1997. There were 276 BRCA1 mutation carriers, 136 BRCA2 carriers, and 1143 women without a known mutation (208 BRCA1/BRCA2 noncarriers and 935 untested women). Patients were stratified according to tumor size, and odds ratios were estimated for the presence of positive lymph nodes with increasing tumor size.
A highly significant positive correlation between tumor size and the frequency of positive axillary lymph nodes was seen for BRCA1/BRCA2 noncarriers, for BRCA2 carriers, and for untested women (overall P < 0.0001 for each). In contrast, there was no clear correlation between tumor size and positive lymph node status in BRCA1 carriers (overall P = 0.20).
The relation between tumor size and lymph node status in patients with breast carcinoma appears to be different in BRCA1 carriers compared with BRCA2 carriers and noncarriers. These findings have important implications for estimating the route of metastatic spread and for evaluating the effectiveness of early diagnosis in patients with BRCA1-related breast carcinoma.
乳腺肿瘤大小与腋窝淋巴结转移癌数量之间的正相关关系已得到充分证实。据报道，与非遗传性乳腺癌患者相比，携带BRCA1基因相关乳腺癌患者更有可能出现淋巴结阴性状态。因此，作者质疑在携带BRCA1基因相关乳腺癌的女性中，肿瘤大小与淋巴结状态之间已知的正相关关系是否也存在。
对1975年至1997年间在北美10个中心确诊的1555例浸润性乳腺癌女性患者，评估切除的乳腺肿瘤最大直径（大小）与腋窝淋巴结转移阳性（以检查的所有淋巴结的百分比表示）之间的关系。其中有276例BRCA1基因突变携带者，136例BRCA2基因突变携带者，以及1143例无已知基因突变的女性（208例BRCA1/BRCA2非携带者和935例未检测的女性）。患者根据肿瘤大小进行分层，并估计随着肿瘤大小增加出现阳性淋巴结的比值比。
在BRCA1/BRCA2非携带者、BRCA2携带者和未检测的女性中，均观察到肿瘤大小与腋窝淋巴结转移阳性频率之间存在高度显著的正相关（每组总体P<0.0001）。相比之下，在BRCA1携带者中，肿瘤大小与阳性淋巴结状态之间没有明显的相关性（总体P=0.20）。
与BRCA2携带者和非携带者相比，BRCA1携带者乳腺癌患者的肿瘤大小与淋巴结状态之间的关系似乎有所不同。这些发现对于估计转移性扩散途径以及评估BRCA1相关乳腺癌患者早期诊断的有效性具有重要意义。
