Escobar Pedro F, Patrick Rebecca J, Rybicki Lisa A, Hicks David, Weng David E, Crowe Joseph P
Department of General Surgery-Breast Center, The Cleveland Clinic Foundation, The Cleveland Clinic Breast Center, 9500 Euclid Avenue, A10, Cleveland, Ohio 44195, USA.
Ann Surg Oncol. 2006 Jun;13(6):783-7. doi: 10.1245/ASO.2006.07.024. Epub 2006 Apr 12.
We performed this study to determine the prognostic significance of clinical tumor size, pathologic measurement of residual tumor, and number of positive axillary nodes in the surgical specimen relative to overall survival for patients who underwent primary induction chemotherapy for advanced breast cancer.
Data, collected prospectively between 1997 and 2002, included clinical tumor-node-metastasis stage, age at diagnosis, hormone receptor status, type of preoperative chemotherapy, histological type, surgical procedure, pathologic measurement in centimeters of residual breast tumor, and the number of positive axillary nodes in the surgical specimen. Univariable correlates of residual breast disease were assessed by using the chi2 test. Recursive partitioning analysis was used to determine the prognostic significance of clinical tumor size, residual tumor size, and pathologic node involvement relative to overall survival. Survival was estimated by using the method of Kaplan and Meier and compared by using the log-rank test. A P value of <.05 was considered significant.
Data were available for 85 patients with advanced breast cancer. Although univariable analysis identified increasing age, clinically involved axillary nodes, and a higher clinical tumor-node-metastasis stage as predictors of an increased risk of residual disease, recursive partitioning analysis identified more than three involved axillary nodes in the surgical specimen, with or without any measurable residual breast disease, as the most significant predictor of decreased survival (P<.001).
Pathologic axillary node involvement was the most significant predictor of decreased survival for patients who had undergone primary induction chemotherapy for advanced breast cancer.
我们开展这项研究，以确定临床肿瘤大小、残余肿瘤的病理测量值以及手术标本中腋窝阳性淋巴结数量相对于接受晚期乳腺癌初次诱导化疗患者总生存期的预后意义。
前瞻性收集1997年至2002年间的数据，包括临床肿瘤-淋巴结-转移分期、诊断时年龄、激素受体状态、术前化疗类型、组织学类型、手术方式、残余乳腺肿瘤的厘米数病理测量值以及手术标本中腋窝阳性淋巴结数量。采用卡方检验评估残余乳腺疾病的单变量相关性。使用递归划分分析来确定临床肿瘤大小、残余肿瘤大小和病理淋巴结受累相对于总生存期的预后意义。采用Kaplan-Meier方法估计生存期，并使用对数秩检验进行比较。P值<.05被认为具有统计学意义。
有85例晚期乳腺癌患者的数据可用。虽然单变量分析确定年龄增加、临床腋窝淋巴结受累以及较高的临床肿瘤-淋巴结-转移分期是残余疾病风险增加的预测因素，但递归划分分析确定手术标本中有超过三个腋窝淋巴结受累，无论有无任何可测量的残余乳腺疾病，是生存期降低的最显著预测因素（P<.001）。
病理腋窝淋巴结受累是接受晚期乳腺癌初次诱导化疗患者生存期降低的最显著预测因素。
