Lee A H S, Gillett C E, Ryder K, Fentiman I S, Miles D W, Millis R R
Hedley Atkins Pathology Laboratory, Guy's Hospital, London, UK.
Histopathology. 2006 May;48(6):692-701. doi: 10.1111/j.1365-2559.2006.02410.x.
Inflammation in carcinoma of the breast may represent an immune response to the tumour, but there is evidence that this response is impaired. Inflammation may also stimulate tumour growth by releasing proteolytic enzymes and angiogenic factors. Prognostic studies have produced conflicting results, but most investigators have not evaluated the different patterns of inflammation. The aim of this study was to test the hypothesis that moderate or marked diffuse inflammation is associated with a better prognosis. We also tested the 'danger model', which suggests that necrosis is necessary for an effective immune response.
On multivariate analysis of women with stage 1 and 2 tumours (n = 679, median follow-up of 9.8 years), survival was independently associated with diffuse inflammation (relative risk 0.43, 95% confidence interval 0.24, 0.77, P =0.005) in addition to histological grade, axillary lymph node status, tumour size and oestrogen receptor status. The presence or absence of tumour necrosis did not have a clear effect on the relationship between survival and diffuse inflammation.
Moderate or marked diffuse inflammation in breast cancer is associated with a better prognosis, suggesting that the immune effects of the inflammation predominate over the protumour effects.
乳腺癌中的炎症可能代表对肿瘤的免疫反应，但有证据表明这种反应受损。炎症还可能通过释放蛋白水解酶和血管生成因子来刺激肿瘤生长。预后研究结果相互矛盾，但大多数研究者并未评估不同的炎症模式。本研究的目的是检验中度或显著弥漫性炎症与较好预后相关这一假设。我们还检验了“危险模型”，该模型认为坏死是有效免疫反应所必需的。
对1期和2期肿瘤患者（n = 679，中位随访时间9.8年）进行多因素分析，除组织学分级、腋窝淋巴结状态、肿瘤大小和雌激素受体状态外，生存与弥漫性炎症独立相关（相对风险0.43，95%置信区间0.24，0.77，P = 0.005）。肿瘤坏死的有无对生存与弥漫性炎症之间的关系没有明显影响。
乳腺癌中的中度或显著弥漫性炎症与较好预后相关，表明炎症的免疫作用超过了促肿瘤作用。
