Colleoni Marco, Zahrieh David, Gelber Richard D, Holmberg Stig B, Mattsson Jan E, Rudenstam Carl-Magnus, Lindtner Jurij, Erzen Darja, Snyder Raymond, Collins John, Fey Martin F, Thürlimann Beat, Crivellari Diana, Murray Elizabeth, Mendiola Caesar, Pagani Olivia, Castiglione-Gertsch Monica, Coates Alan S, Price Karen, Goldhirsch Aron
Division of Medical Oncology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
J Clin Oncol. 2005 Mar 1;23(7):1390-400. doi: 10.1200/JCO.2005.06.052.
Cancer presenting at the medial site of the breast may have a worse prognosis compared with tumors located in external quadrants. For medial tumors, axillary lymph node staging may not accurately reflect the metastatic potential of the disease.
Eight-thousand four-hundred twenty-two patients randomly assigned to International Breast Cancer Study Group clinical trials between 1978 and 1999 were classified as medial site (1,622; 19%) or lateral, central, and other sites (6,800; 81%). Median follow-up was 11 years.
A statistically significant difference was observed for patients with medial tumors versus those with nonmedial tumors in disease-free survival (DFS; 10-year DFS, 46% v 48%; HR, 1.10; 95% CI, 1.02 to 1.18; P = .01) and overall survival (10-year OS 59% v 61%; HR, 1.09; 1.01 to 1.19; P = .04). This difference increased after adjustment for other prognostic factors (HR, 1.22; 95% CI, 1.13 to 1.32 for DFS; and HR, 1.24; 95% CI, 1.14 to 1.35 for OS; both P = .0001). The risk of relapse for patients with medial presentation was largest for the node-negative cohort and for patients with tumors larger than 2 cm. In the subgroup of 2,931 patients with negative axillary lymph nodes, 10-year DFS was 61% v 67%, and OS was 73% v 80% for medial versus nonmedial sites, respectively (HR 1.33; 95% CI, 1.15 to 1.54; P = .0001 for DFS; and HR 1.40; 95% CI, 1.17 to 1.67; P = .0003 for OS).
Tumor site has a significant prognostic utility, especially for axillary lymph node-negative disease, that should be considered in therapeutic algorithms. New staging procedures such as biopsy of the sentinel internal mammary nodes or novel imaging methods should be further studied in patients with medial tumors.
与位于乳腺外象限的肿瘤相比，出现在乳腺内侧部位的癌症可能预后更差。对于内侧肿瘤，腋窝淋巴结分期可能无法准确反映疾病的转移潜能。
1978年至1999年间随机分配到国际乳腺癌研究组临床试验的8422例患者被分为内侧部位（1622例；19%）或外侧、中央及其他部位（6800例；81%）。中位随访时间为11年。
内侧肿瘤患者与非内侧肿瘤患者在无病生存期（DFS；10年DFS，46%对48%；HR，1.10；95%CI，1.02至1.18；P = 0.01）和总生存期（10年OS，59%对61%；HR，1.09；1.01至1.19；P = 0.04）方面观察到有统计学意义的差异。在调整其他预后因素后，这种差异增大（DFS的HR，1.22；95%CI，1.13至1.32；OS的HR，1.24；95%CI，1.14至1.35；P均 = 0.0001）。内侧表现患者的复发风险在腋窝淋巴结阴性队列和肿瘤大于2 cm的患者中最大。在2931例腋窝淋巴结阴性患者的亚组中，内侧部位与非内侧部位的10年DFS分别为61%对67%，OS分别为73%对80%（DFS的HR 1.33；95%CI，1.15至1.54；P = 0.0001；OS的HR 1.40；95%CI，1.17至1.67；P = 0.0003）。
肿瘤部位具有显著的预后价值，尤其是对于腋窝淋巴结阴性疾病，在治疗方案制定中应予以考虑。对于内侧肿瘤患者，应进一步研究前哨内乳淋巴结活检或新型成像方法等新的分期程序。
