Fiets W E, Bellot F E, Struikmans H, Blankenstein M A, Nortier J W R
Department of Clinical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Eur J Surg Oncol. 2005 Mar;31(2):128-33. doi: 10.1016/j.ejso.2004.08.012.
In axillary node negative (ANN) breast cancer patients additional prognostic markers are needed to decide whether adjuvant systemic treatment might be useful.
In the present study, the prognostic relevance of mitotic counts and Bloom-Richardson grade (BR-grade) was evaluated in 164 ANN breast cancer patients. No adjuvant systemic treatment was given to any of these patients. Mitotic counts were determined twice, in routine practice and in revision.
A substantial reproducibility of mitotic counts was found, provided that the cut-off value chosen was high enough. After a median follow-up of 10 years, mitotic counts had no prognostic significance for survival at any cut-off value. A trend towards a significant worse survival was found for patients with Bloom-Richardson grade II or III in comparison with grade I.
Based on data in the literature a positive association between both mitotic counts and BR-grade and survival in ANN breast cancer may exist, but the extent of this putative association and its clinical relevance can be argued, particularly in a group of patients with predominantly well differentiated tumours.
对于腋窝淋巴结阴性（ANN）的乳腺癌患者，需要额外的预后标志物来决定辅助性全身治疗是否有用。
在本研究中，对164例ANN乳腺癌患者评估了有丝分裂计数和布鲁姆-理查森分级（BR分级）的预后相关性。这些患者均未接受辅助性全身治疗。有丝分裂计数在常规操作和复查时各测定一次。
发现有丝分裂计数具有较高的可重复性，前提是所选的临界值足够高。中位随访10年后，有丝分裂计数在任何临界值时对生存均无预后意义。与I级相比，布鲁姆-理查森分级为II级或III级的患者生存有显著变差的趋势。
根据文献数据，ANN乳腺癌的有丝分裂计数和BR分级与生存之间可能存在正相关，但这种假定相关性的程度及其临床相关性仍有争议，尤其是在一组主要为高分化肿瘤的患者中。
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