Dinshaw Ketayun A, Budrukkar Ashwini N, Chinoy Roshan F, Sarin Rajiv, Badwe Rajendra, Hawaldar Rohini, Shrivastava Shyam Kishore
Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India.
Int J Radiat Oncol Biol Phys. 2005 Nov 15;63(4):1132-41. doi: 10.1016/j.ijrobp.2005.03.071. Epub 2005 Jun 22.
The outcome of breast cancer treatment can vary in different geographic and ethnic groups. A multivariate analysis was performed for various prognostic factors in 1022 Indian women with pathologic Stage I-II breast cancer treated between 1980 and 2000 with standard breast-conserving therapy with or without systemic adjuvant therapy.
At a mean follow-up of 53 months, the outcomes studied were local failure, locoregional failure, and distant failure, overall survival (OS), and disease-free survival (DFS).
The median pathologic tumor size was 3 cm (range, 1-5 cm), and axillary lymph node metastasis was present in 39% of women. The actuarial 5- and 10-year OS and DFS rate was 87% and 77% and 76% and 68%, respectively. Lymphovascular emboli or invasion (LVI) was the strongest independent adverse factor for all failure and survival (local failure, hazard ratio 2.85; 95% confidence interval, 1.68-4.83; OS; hazard ratio, 2.01, 95% confidence interval, 1.35-2.99). Lymph node metastasis was also an independent adverse factor for local failure, locoregional failure, distant failure, DFS, and OS (hazard ratio, 1.55, 95% confidence interval, 1.04-2.30). Age < or =40 years increased the incidence of local recurrence, and patients with inner quadrant tumors had inferior DFS. The incidence of LVI was significantly greater in women with lymph node metastases than in node-negative women (p < 0.001) and in women with Grade 3 tumors than in those with Grade 1 or 2 tumors (p = 0.001).
In Indian women, LVI was the strongest independent prognostic factor for OS, DFS, and local recurrence, irrespective of nodal status and systemic adjuvant treatment. Although LVI may not be a contraindication for BCT, as has been proposed by certain groups, it is necessary to define its role in prospective studies in determining local and systemic treatment.
乳腺癌治疗的结果在不同地理和种族群体中可能有所不同。对1980年至2000年间接受标准保乳治疗（无论是否接受全身辅助治疗）的1022例病理分期为I-II期的印度乳腺癌女性患者的各种预后因素进行了多因素分析。
平均随访53个月，研究的结果包括局部复发、区域复发和远处复发、总生存期（OS）和无病生存期（DFS）。
病理肿瘤大小中位数为3cm（范围1-5cm），39%的女性存在腋窝淋巴结转移。5年和10年的精算总生存率和无病生存率分别为87%和77%以及76%和68%。淋巴管栓子或侵犯（LVI）是所有复发和生存（局部复发，风险比2.85；95%置信区间，1.68-4.83；总生存期；风险比，2.01，95%置信区间，1.35-2.99）的最强独立不良因素。淋巴结转移也是局部复发、区域复发、远处复发、无病生存期和总生存期的独立不良因素（风险比，1.55，95%置信区间，1.04-2.30）。年龄≤40岁会增加局部复发的发生率，内象限肿瘤患者的无病生存期较差。LVI的发生率在有淋巴结转移的女性中显著高于无淋巴结转移的女性（p<0.001），在3级肿瘤女性中显著高于1级或2级肿瘤女性（p=0.001）。
在印度女性中，无论淋巴结状态和全身辅助治疗如何，LVI都是总生存期、无病生存期和局部复发的最强独立预后因素。尽管如某些研究组所提出的，LVI可能不是保乳治疗的禁忌证，但有必要在前瞻性研究中确定其在确定局部和全身治疗中的作用。
