Coombs Nathan J, Boyages John
New South Wales Breast Cancer Institute, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia.
J Clin Oncol. 2005 Oct 20;23(30):7497-502. doi: 10.1200/JCO.2005.02.1147.
The identification of multiple tumors in the breast is associated with increased nodal involvement when compared with similar staged unifocal disease. This study compares two methods of tumor size assessment to predict tumor behavior in the relationship between size and axillary node involvement for patients with multifocal and multicentric breast cancer.
The histologic reports of every patient with multifocal breast cancer treated in New South Wales between April 1995 and September 1995 were examined. Tumors were assessed using two size estimates: (1) largest tumor focus diameter and (2) the aggregate diameters of all tumor foci. The dimensions were compared with unifocal tumors and against node positivity.
Ninety-four (11.1%) of 848 women had multifocal breast cancer and of these 49 women (52.1%) had axillary node involvement compared with 37.5% with unifocal breast cancer (P =.007). The use of aggregate dimension reclassified significant numbers of multifocal tumors at a more advanced stage. Use of this method to stage cancers, rather than the largest tumor size, removed the excess node positivity when compared with unifocal, stage-matched breast carcinomas.
The tendency of breast tumors to metastasize is a reflection of the total tumor load. Failure to measure the additional tumor burden provided by multiple small foci may understage a woman's disease. This may deny patients the opportunity of adjuvant therapies if the contribution of the smaller foci to the incidence of node positivity and survival is ignored.
与分期相似的单灶性疾病相比，乳腺多原发肿瘤与腋窝淋巴结受累增加相关。本研究比较两种肿瘤大小评估方法，以预测多灶性和多中心性乳腺癌患者肿瘤大小与腋窝淋巴结受累关系中的肿瘤行为。
检查了1995年4月至1995年9月在新南威尔士州接受治疗的每例多灶性乳腺癌患者的组织学报告。使用两种大小估计值评估肿瘤：（1）最大肿瘤灶直径，（2）所有肿瘤灶的总直径。将这些尺寸与单灶性肿瘤以及淋巴结阳性情况进行比较。
848名女性中有94名（11.1%）患有多灶性乳腺癌，其中49名女性（52.1%）有腋窝淋巴结受累，而单灶性乳腺癌患者的这一比例为37.5%（P = 0.007）。使用总直径重新分类了大量处于更晚期的多灶性肿瘤。与分期匹配的单灶性乳腺癌相比，使用这种方法对癌症进行分期，而不是最大肿瘤大小，消除了多余的淋巴结阳性情况。
乳腺肿瘤转移的倾向是总肿瘤负荷的反映。未能测量多个小病灶提供的额外肿瘤负担可能会低估女性疾病的分期。如果忽略较小病灶对淋巴结阳性发生率和生存率的影响，这可能会使患者失去接受辅助治疗的机会。
