Wolman S R, Feiner H D, Schinella R A, Gimotty P, Ownby H, Maloney T, Dawson P J
Michigan Cancer Foundation, Detroit 48201.
Hum Pathol. 1991 May;22(5):475-80. doi: 10.1016/0046-8177(91)90134-b.
We reviewed tumors from two groups of patients with breast cancer, distinguished by differences in outcome. One group (85 cases) survived more than 8.5 years without tumor recurrence; the other 85 cases had recurrent disease within 2 years. Histologic and immunocytochemical studies on all cases were performed without patient identifiers and prior to review of clinical prognostic factors. As expected, lymph node and estrogen receptor status differed substantially between the groups, but menopausal status and family history for breast cancer did not. We noted that 27% of node-negative patients died within 5 years, and nine patients with four or more tumor-containing nodes were symptom-free for over 8.5 years. Histologic grade (degree of tubule formation) and nuclear grade (including mitotic rate) differed significantly between the groups, as did vascular invasion, including both lymphatics and blood vessels. Prognostic value attached to tumor border only when fat was invaded without fibroblastic or inflammatory response (P = .012). Subgrouping cases of infiltrating ductal carcinoma (not otherwise specified) was prognostically informative in the B subgroup, 69% of whom were in the rapidly recurrent tumor group. Immunocytochemical staining for c-erbB-2 was positive in 19.3% of cases, but was equally distributed between the two outcome groups. We conclude that traditional histologic parameters are highly informative, and that c-erbB-2 studies do not increase the value of histologic diagnosis.
我们回顾了两组乳腺癌患者的肿瘤情况，这两组患者的预后有所不同。一组（85例）存活超过8.5年且无肿瘤复发；另一组85例在2年内出现疾病复发。对所有病例进行了组织学和免疫细胞化学研究，研究过程中未使用患者标识符，且在回顾临床预后因素之前进行。正如预期的那样，两组之间的淋巴结和雌激素受体状态存在显著差异，但绝经状态和乳腺癌家族史并无差异。我们注意到，27%的淋巴结阴性患者在5年内死亡，而9例有4个或更多含肿瘤淋巴结的患者在8.5年以上无症状。两组之间的组织学分级（小管形成程度）和核分级（包括有丝分裂率）存在显著差异，血管侵犯（包括淋巴管和血管）情况也是如此。仅当脂肪被侵犯且无成纤维细胞或炎症反应时，肿瘤边界才有预后价值（P = 0.012）。对浸润性导管癌（未另作说明）病例进行亚组分析在B亚组中具有预后指导意义，其中69%属于肿瘤快速复发组。c-erbB-2免疫细胞化学染色在19.3%的病例中呈阳性，但在两个预后组中的分布相同。我们得出结论，传统的组织学参数具有很高的信息量，并且c-erbB-2研究并未增加组织学诊断的价值。
