Joslyn Sue A, Konety Badrinath R
University of Northern Iowa, 221 WRC, Cedar Falls, IA 50614-0241, USA.
Breast Cancer Res Treat. 2005 May;91(1):11-8. doi: 10.1007/s10549-004-6276-7.
To determine the effect of axillary lymphadenectomy on breast carcinoma survival, and to determine racial and age differences in the extent of axillary lymphadenectomy.
Cases were 257,157 women diagnosed with breast carcinoma in the Surveillance, Epidemiology and End Results program from 1988 through 2000. Variables included number of lymph nodes removed, number of positive lymph nodes, ratio of positive nodes to number of nodes removed, use of radiation therapy, surgery (breast conserving surgery versus mastectomy), stage, age, race, and hormone receptor status. Correlation statistics were used to determine associations between survival and lymph node variables for all cases and when stratified by stage. Kaplan-Meier survival analyses were used to compare survival by lymph node categories overall and stratified by stage. Cox regression analyses were used to determine factors associated with survival.
Older women were significantly less likely to have lymph nodes examined and lymph node involvement compared to younger women, and black women were significantly less likely to have lymph nodes examined, but were significantly more likely to have lymph node involvement compared to white women. Risk of death was significantly reduced for cases who had lymphadenectomy compared to those who did not. For cases diagnosed at stage IIA or higher, risk of death increased significantly with increased number of positive nodes and increased ratio of positive to total nodes removed.
Improved survival in node negative cases of breast carcinoma may be due to removal of undetected micrometastases. Women diagnosed at more advanced stages as well as black women may also benefit from more extensive lymphadenectomy.
确定腋窝淋巴结清扫术对乳腺癌生存率的影响，并确定腋窝淋巴结清扫范围在种族和年龄上的差异。
病例为1988年至2000年在监测、流行病学和最终结果项目中诊断为乳腺癌的257,157名女性。变量包括切除的淋巴结数量、阳性淋巴结数量、阳性淋巴结与切除淋巴结数量的比例、放疗的使用、手术方式（保乳手术与乳房切除术）、分期、年龄、种族和激素受体状态。使用相关统计方法确定所有病例以及按分期分层时生存率与淋巴结变量之间的关联。采用Kaplan-Meier生存分析比较总体及按分期分层的不同淋巴结分类的生存率。使用Cox回归分析确定与生存相关的因素。
与年轻女性相比，老年女性接受淋巴结检查和出现淋巴结受累的可能性显著降低；与白人女性相比，黑人女性接受淋巴结检查的可能性显著降低，但出现淋巴结受累的可能性显著增加。与未进行淋巴结清扫术的病例相比，进行了淋巴结清扫术的病例死亡风险显著降低。对于IIA期或更高分期诊断的病例，死亡风险随着阳性淋巴结数量的增加以及阳性与总切除淋巴结比例的增加而显著增加。
乳腺癌淋巴结阴性病例生存率的提高可能归因于未检测到的微转移灶的清除。诊断为更晚期的女性以及黑人女性也可能从更广泛的淋巴结清扫术中获益。
