Bosari S, Lee A K, Tahan S R, Figoni M A, Wiley B D, Heatley G J, Silverman M L
Department of Anatomic Pathology, Lahey Clinic Medical Center, Burlington, Massachusetts 01805.
Cancer. 1992 Oct 1;70(7):1943-50. doi: 10.1002/1097-0142(19921001)70:7<1943::aid-cncr2820700722>3.0.co;2-y.
The prognostic significance of flow cytometric analysis in patients with node-negative invasive breast carcinoma was evaluated in a retrospective series of 158 patients with a minimum follow-up study of 9 years.
The ploidy status could be assessed in 147 specimens (93%), and the proliferative phase or S-phase fraction (SPF) could be assessed in 136 tumors (86%); 70 tumors (48%) were diploid, 49 tumors (33%) were aneuploid, and 28 tumors (19%) were tetraploid. Ploidy status and SPF were correlated significantly with tumor size, histologic grade, nuclear grade, and mitotic rate. By itself, ploidy was not a statistically significant prognostic factor, although all of the patients with multiploid and hypertetraploid tumors had recurrence of disease. The SPF was related significantly to recurrence of disease (P = 0.04). However, when multivariate analysis of various histopathologic variables was performed, SPF ceased to be a significant prognostic determinant, whereas peritumoral lymphovascular invasion was the most important variable. The combination of tumor size and flow cytometric parameters permitted stratification into three groups with different prognoses at the 9-year follow-up review (P less than 0.001). In the low-risk group (diploid tumors less than or equal to 2 cm in diameter with a low SPF or small tetraploid tumors), the recurrence rate was 12%. In the intermediate-risk group (diploid tumors greater than 2 cm in diameter with a low SPF or aneuploid tumors with a low SPF), the recurrence rate was 21%. In the high-risk group (diploid or aneuploid tumors with a high SPF or large tetraploid tumors), the recurrence rate was 49%. The high-risk group status remained a significant variable in the Cox proportional hazards multivariate analysis model.
These results indicate that flow cytometry in breast carcinoma contributes useful but limited prognostic information and stress the importance of using multiple prognostic factors to improve prognostication and optimize patient management.
对158例淋巴结阴性浸润性乳腺癌患者进行回顾性研究，评估流式细胞术分析在这些患者中的预后意义，其最短随访时间为9年。
147份标本（93%）可评估倍体状态，136例肿瘤（86%）可评估增殖期或S期分数（SPF）；70例肿瘤（48%）为二倍体，49例肿瘤（33%）为非整倍体，28例肿瘤（19%）为四倍体。倍体状态和SPF与肿瘤大小、组织学分级、核分级和有丝分裂率显著相关。单独来看，倍体并非具有统计学意义的预后因素，尽管所有多倍体和超四倍体肿瘤患者均出现疾病复发。SPF与疾病复发显著相关（P = 0.04）。然而，在对各种组织病理学变量进行多变量分析时，SPF不再是显著的预后决定因素，而肿瘤周围淋巴管浸润是最重要的变量。在9年随访复查中，肿瘤大小与流式细胞术参数的组合可将患者分为三组，其预后不同（P < 0.001）。在低风险组（直径小于或等于2 cm的二倍体肿瘤且SPF低或小四倍体肿瘤）中，复发率为12%。在中风险组（直径大于2 cm的二倍体肿瘤且SPF低或SPF低的非整倍体肿瘤）中，复发率为21%。在高风险组（SPF高的二倍体或非整倍体肿瘤或大四倍体肿瘤）中，复发率为49%。在Cox比例风险多变量分析模型中，高风险组状态仍然是一个显著变量。
这些结果表明，乳腺癌中的流式细胞术提供了有用但有限的预后信息，并强调了使用多种预后因素以改善预后评估和优化患者管理的重要性。
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