Michaelson James S, Silverstein Melvin, Sgroi Dennis, Cheongsiatmoy Justin A, Taghian Alphonse, Powell Simon, Hughes Kevin, Comegno Arthur, Tanabe Kenneth K, Smith Barbara
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
Cancer. 2003 Nov 15;98(10):2133-43. doi: 10.1002/cncr.11765.
It has long been known that both tumor size and the presence of malignant disease in the regional lymph nodes are indicators of outcome for patients with invasive breast carcinoma; however, the way in which these two characteristics could be integrated into an overall assessment of prognosis has not been obvious.
Kaplan-Meier survival estimates (15 years) according to tumor size and lymph node status were obtained for women with invasive breast carcinoma who were observed at the University of Southern California/Van Nuys Breast Center (Van Nuys, California) or at Massachusetts General Hospital (Boston, Massachusetts).
To isolate the individual contributions to death made by tumor size and lymph node status, data were sorted according to both of these variables. For women with tumors of equivalent size, lethality increased with increasing number of positive lymph nodes, such that there was an extra approximately 6% chance of death associated with each positive lymph node. For women with equivalent lymph node status, tumor size was associated with increased lethality, such that each millimeter of tumor diameter was associated with an additional approximately 1% chance of death. The overall lethality was equal to the sum of the contribution from lymph node status and the contribution from tumor size, and this finding led to the creation of a new technique (the Size+Nodes method) for predicting outcome.
The Size+Nodes method was shown to be capable of accurately estimating the risk of death due to invasive breast carcinoma from information on the size of the primary tumor and the number of positive lymph nodes. In addition, this method was used to stratify women into groups according to breast carcinoma lethality. In contrast, classification of women according to lymph node positivity, T status, or disease stage created groups with wide and overlapping levels of lethality.
长期以来，人们都知道肿瘤大小和区域淋巴结中恶性疾病的存在都是浸润性乳腺癌患者预后的指标；然而，如何将这两个特征整合到一个整体的预后评估中并不明确。
获取了在南加州大学/凡奈斯乳腺中心（加利福尼亚州凡奈斯）或麻省总医院（马萨诸塞州波士顿）接受观察的浸润性乳腺癌女性患者根据肿瘤大小和淋巴结状态的Kaplan-Meier生存估计值（15年）。
为了分离肿瘤大小和淋巴结状态对死亡的个体影响，数据根据这两个变量进行了分类。对于肿瘤大小相当的女性，随着阳性淋巴结数量的增加，致死率上升，以至于每个阳性淋巴结会额外增加约6%的死亡几率。对于淋巴结状态相当的女性，肿瘤大小与致死率增加相关，以至于肿瘤直径每增加一毫米会额外增加约1%的死亡几率。总体致死率等于淋巴结状态的影响与肿瘤大小的影响之和，这一发现促成了一种预测预后的新技术（大小+淋巴结方法）的产生。
大小+淋巴结方法被证明能够根据原发肿瘤大小和阳性淋巴结数量的信息准确估计浸润性乳腺癌导致的死亡风险。此外，该方法还被用于根据乳腺癌致死率将女性分层分组。相比之下，根据淋巴结阳性情况、T分期或疾病阶段对女性进行分类会产生致死率水平宽泛且相互重叠的分组。
